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.
Hepatic injury may be present due to thermal stress, tissue hypoperfusion, and indirect effects of heat stroke. Liver failure may occur.[1][2]
Treatment involves intensive care unit monitoring, conservative management, and possible liver transplantation in those who do not recover despite optimal conservative treatment.[32]
Consequence of damage to muscles under thermal stress.
Myoglobin released can overload renal filtering systems, and can result in acute renal failure.
Effects of myoglobinaemia vary, but generally athletes and young, healthy people are more able to tolerate high myoglobin levels without renal compromise.
Treatment objectives are to alkalinise 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.[33] Once disseminated intravascular coagulation is present in a patients with heat stroke, it is often difficult to reverse.
Patients may require treatment with clotting factors and platelets.
Multi-system 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.[34]
Use of this content is subject to our disclaimer