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• W2912061050 abstract "Exertional heat stroke is a life-threatening condition characterised by hyperpyrexia and predominant central nervous system dysfunction, resulting in delirium, convulsion or coma.1 Initial symptoms of heat stroke typically present with digestive complications, including vomiting or diarrhoea, culminating in a life-threatening situation such as hypovolemic shock. Therefore, adequate oral hydration during exercise in hot and humid weather is recommended to avoid severe dehydration. However, excessive dehydration impairs water absorption in the gastrointestinal tract, resulting in a situation for which oral rehydration is ineffective. Here, we describe a 13-year-old boy who developed severe heat stroke during baseball practice despite ingestion of adequate fluids. A 13-year-old boy was admitted to the hospital with vomiting and convulsive collapse during baseball practice on a hot (28°C), humid day. He had consumed a sufficient amount of isotonic water every 30 min during practice. Upon admission, his core temperature was 41.0°C, and he was hypotensive. He was intubated and rapidly infused with a total of 2.5 L of extracellular fluid to recover from shock status and transferred to our hospital. Initial serum findings showed elevated blood urea nitrogen and creatinine. Furthermore, rhabdomyolysis was indicated by elevated creatine phosphokinase and myoglobin. Despite his dehydrated condition, abdominal computed tomography (CT) imaging showed massive fluid retention within dilated intestinal loops (Fig. 1). He was treated with continuous plasma diafiltration using cold fresh frozen plasma to normalise the hyperthermia and myoglobin.2 This approach reduced his body temperature to 37°C within 24 h, and normal renal function was restored in 5 days. He was discharged after abdominal CT confirmed normal intestinal findings. Heat dissipation in high-temperature environments is facilitated by initially increasing blood flow to the skin, which decreases blood flow to the visceral organs.3 To avoid progression to dehydration, oral hydration is of paramount importance. However, excessive dehydration impairs water absorption due to intestinal mucosal atrophy, leading to massive intestinal liquid retention, as shown in Figure 1. One report has described similar abdominal CT findings from a patient with haemorrhagic shock,4 indicating that hypovolemia is one of the main causes of intestinal ischaemia that leads to impaired water absorption. In conclusion, paediatricians should advice sports coaches and school teachers about the appropriate timing of oral rehydration: before manifestation of intestinal ischemic symptoms such as vomiting or diarrhoea." @default.
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• W2912061050 date "2019-02-01" @default.
• W2912061050 modified "2023-09-25" @default.
• W2912061050 title "Massive intestinal liquid retention in a case of severe heat stroke" @default.
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• W2912061050 doi "https://doi.org/10.1111/jpc.14343" @default.
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