Complications
Acute respiratory distress syndrome can develop rapidly and may require mechanical ventilation.
Heat stroke is often accompanied by a systemic inflammatory cascade (prostaglandins and other inflammatory mediator release) leading to lowered systemic vascular resistance and cardiac failure.
Fluid resuscitation is given with crystalloids, and early central venous pressure monitoring is indicated. Vasopressors can be started for persistent hypotension or myocardial failure.
Shock, hypoxia, acid-base imbalances, and rhabdomyolysis can all place stress on the renal filtering system, and acute kidney injury is not uncommon.
Mainstay of treatment is supportive care, with correction of acid-base, electrolyte, and volume complications.
Occurs both from thermal strain and as a manifestation of the central nervous system disturbances seen with heat stroke. Benzodiazepines are used to control seizures; centrally acting antipyretics are ineffective.
Consequence of damage to muscles under thermal stress.
Myoglobin released can overload renal filtering systems, and can result in acute renal failure.
Effects of myoglobinemia vary, but generally athletes and young, healthy people are more able to tolerate high myoglobin levels without renal compromise.
Treatment objectives are to alkalinize the urine to a pH >6.5 and to ensure flushing of myoglobin. Forced diuresis with sodium bicarbonate infusion may prevent acute kidney injury. Urine output must be maintained at a rate of >300 mL/hour, and normal saline infusion is given at rate of 1.5 L/hour until the myoglobinuria stops or the creatine kinase (CK) level is <1000 U/L. Serial CK levels should be monitored.
Clotting systems can fail under excessive thermal stress.[22] Once disseminated intravascular coagulation is present in patients with heat stroke, it is often difficult to reverse.
Patients may require treatment with clotting factors and platelets.
Multisystem organ failure may occur.
Treatment includes supportive therapy, as well as specific interventions for each organ: mechanical ventilation for respiratory failure, dialysis for renal failure, vasopressors for hypotension, and clotting factors and platelets for coagulopathy.
Observational data indicate that, over a 14-year follow-up period, patients with a history of heat stroke are at increased risk of cardiovascular disease (myocardial infarction, stroke) compared with control patients.[51]
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