Severe Liver Failure in Exertional Heat Stroke

Abstract

Exertional heat stroke usually occurs in warm climates. Increased serum levels of liver enzymes is a common finding in this condition, whereas liver failure is a more rare event that carries a poor prognosis. Liver transplantation has been recommended as treatment in cases of severe liver failure, but no long-term survival after this procedure in exertional heat stroke has been described. We report the case of a 31-year-old man who had a heat stroke after running 5 km at 21 degrees C. He developed severe liver damage, with serum alanine aminotransferase (ALAT) activities increasing to 16,410 U/l (reference values, 10-50 U/l) after 48 h, concomitantly with a pronounced coagulation disturbance, with Normotest (NT) decreasing to 12% (international normalized ratio (INR) = 4.2) (reference values, 70%-130% for NT and 0.8-1.2 for INR). A liver biopsy on the 5th day after the incident showed extensive liver cell necrosis. The patient was referred to be considered for liver transplantation but recovered completely on conservative treatment. We conclude that exertional heat stroke is a diagnostic possibility also in temperate climates and that severe liver failure may ensue. The liver injury is reversible, and the indications for liver transplantation in this situation have not been clarified.

Management of Heat-Related Illness and Injury in the ICU: A Concise Definitive Review

“…The occurrence of organ dysfunction is high in both categories of heat stroke (3). Clinical features of system dysfunction are depicted in Figure 1 (3, 14, 29–33).…”

Letaler Hitzeschock mit disseminierter intravasaler Koagulopathie

“…Im fulminanten Leberversagen kann eine Leberdialyse (MARS) erwogen werden [6]. Es gibt einige Fallberichte über Patienten, die infolge einer Leberschädigung durch den Hitzschlag eine notfallmäßige Lebertransplantation bekommen mussten und dadurch die Erkrankung gut überstanden [17,22].…”

An Analytical Study on Acute Liver Injury in Patients Caused by Classic Heat stroke

“…In the case study, a man got heat stroke after running 5 km at 21 0 C as a result serum alanine aminotransferase (ALAT) activities increasing to 16,410 U/I after two days that causes severe liver damage. The patient referred for liver transplant surgery bur curer completely with conservative treatment [13]. The reported studies in the literature only discussed about the impact of heat stroke on liver functionality based on the variation in biochemical in the normal conditions but none of the studies discussed about the impact of heat stroke in liver injury during the hospital stay.…”