Hypothermia after Cooling Therapy in Exertional Heat Stroke: A Case Study

Article Sidebar

PDF
Published: Sep 20, 2018
DOI: https://doi.org/10.31524/bkkmedj.2018.09.014
Keywords:
heat stroke, heat injury, hypothermia, core temperature, core temperature afterdrop

Main Article Content

Sarinpant Pongpant, MD
Pitchaya Phakthongsuk, MD
Rungsun Bhurayanontachai, MD

Abstract

Exertional heat stroke is an emergency condition which can be found inoccupational settings. Pre-hospital and medical management is essential for preventionof morbidity and mortality. A 33-year old male ranger was sent to a district hospitalpresenting with unconsciousness and generalized tonic-clonic seizure. His had an axillarytemperature of 42ºC, blood pressure of 60/40 mmHg and heart rate of 160 beats perminute (bpm), His blood glucose level was 59 mg/dL. Exertional heat stroke wassuspected. He was resuscitated, intubated, medicated and referred to a tertiary hospital.During an hour of transportation, his body was submerged in ice and water. At thetertiary hospital, his esophageal temperature was 29ºC with presentation of Osborn wavein electrocardiogram and electrolyte imbalances. After rewarming and correction ofelectrolytes in the intensive care unit, he gained consciousness the following day. A dayafter that, hyperthermia developed from Enterococcus faecalis septicemia whichresponded to medication. On admission day 6, physical examination showed onlyweakness of his right nasolabial fold. Although this patient had minor complications,lethal or serious outcomes could have occurred in this patient. This report emphasizes theneed for early recognition and proper medical care in heat illness.

Article Details

How to Cite
1.
Pongpant S, Phakthongsuk P, Bhurayanontachai R. Hypothermia after Cooling Therapy in Exertional Heat Stroke: A Case Study. BKK Med J [Internet]. 2018 Sep. 20 [cited 2024 Apr. 20];14(2):76. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/222565
Issue
Vol. 14 No. 2 (2018): September
Section
Case Report

This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

1. EPA, CDC. Climate change and extreme heat what you can doto prepare. 2016.
2. Bouchama A, Knochel JP. Heat stroke. N Engl J Med2002;346:1978-88.
3. Miyake Y. Pathophysiology of Heat Illness: Thermoregulation,risk factors, and indicators of aggravation. JMAJ 2013;56.
4. Glazer JL. Management of heatstroke and heat exhaustion. AmFam Physician 2005;71:2133-40.
5. Bouchama A. Pathogenetic mechanisms of heatstroke andnovel therapies. Crit Care 2012;16:A7.
6. Kjellstrom T, Holmer I, Lemke B. Workplace heat stress, healthand productivity – an increasing challenge for low andmiddle-income countries during climate change. Glob HealthAction 2009;2:2047.
7. Smith KR, Woodward A, Campbell-Lendrum D, et al. Humanhealth: impacts, adaptation, and co-benefits. Climate change2014: impacts, adaptation, and vulnerability. part A: Global andsectoral aspects. contribution of working group ii to the fifthassessment report of the intergovernmental panel of climatechange. Cambridge, United Kingdom and New York, NY, USA:Cambridge University Press 2014:709-54.
8. Epstein Y, Druyan A, Heled Y. Heat Injury Prevention—AMilitary Perspective. J Strength Cond Res 2012;26:S82-S6.
9. Lucas RAI, Epstein Y, Kjellstrom T. Excessive occupationalheat exposure: a significant ergonomic challenge and healthrisk for current and future workers. Extrem Physiol Med2014;3:14.
10. Chan YK, Mamat M. Management of heat stroke. Trends inAnaesthesia and Critical Care 2015;5:65-9.
11. Jacklitsch B, Williams WJ, Musolin K, et al. Occupationalexposure to heat and hot environments. In: Department OfHealth And Human Services, CDC., editors.: NIOSH; 2016.
12. Leon LR, Helwig BG. Heat stroke: Role of the systemicinflammatory response. J Appl Physiol 2010;109:1980-8.
13. Lipman GS, Eifling KP, Ellis MA, et al. Wilderness MedicalSociety Practice Guidelines for the Prevention and Treatmentof Heat-Related Illness: 2014 Update. Wilderness Environ Med2014;25:S55-S65.
14. Mahant S. The evaluation and management of heat injuries inan intensive care unit. . Indian J Crit Care Med 2015;19:479-83.
15. Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke. JEmerg Med 2016;50:607-16.
16. Petrone P, Asensio JA, Marini CP. Management of accidentalhypothermia and cold injury. Curr Probl Surg 2014;51:417-31.
17. Zafren K, Giesbrecht GG, Danzl DF, et al. Wilderness MedicalSociety Practice Guidelines for the Out-of-Hospital Evaluationand Treatment of Accidental Hypothermia: 2014 Update.Wilderness Environ Med 2014;25:S66-S85.
18. Platt M, Vicario S. Heat illness. In: Marx JA, editor. Rosen’semergency medicine: concepts and clinical practice. 2. 7th ed.China: MosbyElsevier; 2010. p. 1882-92.
19. Sithinamsuwan P, Piyavechviratana K, Kitthaweesin T, et al.Exertional heatstroke: early recognition and outcome with aggressivecombined cooling- a 12-year experience. Mil Med2009;174:496-502.
20. Knochel JP, Caskey JH. The mechanism of hypophosphatemiain acute heat stroke. JAMA 1977;238:425-6.
21. Ahmed A, Sadaniantz A. Metabolic and electrolyteabnormalities during heat exhaustion. Postgrad Med J1996;72:505-6.
22. Mazerolle SM, Ganio MS, Casa DJ, et al. Is Oral Temperaturean Accurate Measurement of Deep Body Temperature? ASystematic Review. J Athl Train 2011;46:566-73.
23. Bouchama A, Dehbi M, Chaves-Carballo E. Cooling andhemodynamic management in heatstroke: practicalrecommendations. Crit Care 2007;11:R54.
24. Pryor RR, Casa DJ, Holschen JC, et al. Exertional Heat Stroke:Strategies for Prevention and Treatment From the Sports Fieldto the Emergency Department. Clin Pediatr Emerg Med2013;14:267-78.
25. Danzl DF. Accidental hypothermia. In: Marx JA, editor. Rosen’semergency medicine: concepts and clinical practice. 2. 7th ed.China: MosbyElsevier; 2010. p. 1868-81.
26. Stewart TE, Whitford AC. Dangers of Prehospital Cooling: ACase Report of Afterdrop in a Patient with Exertional HeatStroke. J Emerg Med 2015;49:630-3.
27. Hong J-Y, Lai Y-C, Chang C-Y, et al. Successful Treatment ofSevere Heatstroke With Therapeutic Hypothermia by aNoninvasive External Cooling System. Ann Emerg Med2012;59:491-3.
28. Lee EJ, Lee SW, Park JS, et al. Successful treatment of severeheat stroke with selective therapeutic hypothermia using anautomated surface cooling device. Resuscitation 2013;84:e77-8.
29. MacLean D, Stevenson R, Bata I, et al. Therapeutichypothermia for out-of-hospital cardiac arrest: An analysiscomparing cooled and not cooled groups at a Canadian center.J Emerg Trauma Shock 2012;5:328-32.
30. Campbell KE, Brundage JF. Effects of climate, latitude, andseason on the incidence of Bell’s palsy in the US ArmedForces, October 1997 to September 1999. Am J Epidemiol2002;156:32-9.
31. Casa DJ, Armstrong LE, Kenny GP, et al. Exertional heat stroke:new concepts regarding cause and care. Curr Sports Med Rep2012;11:115-23.
32. Jacklitsch B, Williams W, Musolin K, et al. NIOSH criteria fora recommended standard: occupational exposure to heat andhot environments.: U.S. Department of Health and HumanServices, Centers for Disease Control and Prevention,National Institute for Occupational Safety and Health, DHHS(NIOSH); 2016.