Fatal heat stroke based on foudroyant irreversible multiple organ dysfunction in German summer

Abstract

Objectives: Heat stroke is a serious condition that might lead from moderate organ impairment to multiple organ dysfunction syndrome. Appropriate diagnosis-finding, fast initiation of cooling and intensive care are key measures of the initial treatment. Scientific case report based on i) clinical experiences obtained in the clinical management of a particularly rare case and ii) selected references from the medical scientific literature.

Case presentation: We present a case of a young and healthy construction worker who suffered from an exertional heat stroke with a body core temperature exceeding 42 °C by previous several hour work at 35 °C ambient temperature. Heat stroke was associated with foudroyant, not reversible multiple organ dysfunction syndrome, in particular, early disturbed coagulation, microcirculatory, liver and respiratory failure, and subsequent fatal outcome despite immediate diagnosis-finding, rapid external cooling and expanded intensive care management.

Conclusions: Basic knowledge on an adequate diagnosis(-finding in time) and treatment of heat stroke is important for (almost each) physician in the summertime as well as is essential for the initiation of an appropriate management. Associated high morbidity and mortality rates indicate the need for implementation of standard operation protocols.

Keywords: cooling; disseminated intravascular coagulation; heat stroke; intensive care; liver transplantation; multiple organ failure.

Figure 1:

Time course of laboratory parameters since patient’s admission. (A) Myoglobin, (B) AST and ALT, (C) GLDH, (D) troponin T, (E) LDH and CK.

Figure 2:

Substitution of blood products and factors according to the course of various aggregation- and coagulation-relevant parameters and factors. (A) Red cell packs, (B) platelet concentrate, (C) antithrombin, (D) fibrinogen, (E) factor 13, (F) PPSB, and (G) FFP’s.