While cardiopulmonary symptoms are common in patients undergoing classical or, due to physical exercise, exertional heat stroke, the failure of other organs is a rarely described phenomenon. Here we present two cases of acute hepatic failure, one due to classic heat shock, while the other occurred while the patient was doing a marathon-type running. Both cases presented with very
high transaminases and significantly elevated international normalized ratio (INR). No other causes for liver failure could be identified but physical exhaustion and hyperthermia.Keywords: Heat stroke, Acute hepatic failure, Heat shock, Liver failure, Hyperthermia Go to:
INTRODUCTION
Heat stroke is a life-threatening condition that can be fatal if proper assessment and treatment are not initiated rapidely. A variable degree of organ involvement is present in heat stroke[3]. At the beginning, there is heat exhaustion, characterized by nonspecific symptoms such as malaise, headache and nausea.
Untreated this illness results in heat stroke, a serious disease possibly involving central nervous system dysfunction, rhabdomyolysis, arrhythmias, disseminated intravascular coagulation and hepatic failure, not uncommon followed by death.
The current model of heat stroke favors hyperthermia as trigger, while endotoxaemia drives the disease. However, the pathology is not fully understood. In athletes undergoing intense training a variety of immune and gastrointestinal disturbances can occur. We here describe two completely different causes of heat stroke resulting in acute and severe liver failure as leading symptom.
