Abstract Introduction: Heat stroke is a life-threatening condition, defined by core body temperature 40 °C, along with hot, dry skin and severe CNS dysfunction. It has various clinical manifestations, diagnostic features, and complications. Identifying risk factors of heat stroke is important in properly treating patients. The treatment includes rapid cooling (invasive and noninvasive) and supportive care. Case A 68-year-old woman with a past medical history of hypertension, atrial fibrillation, epilepsy on zonisamide, depression, and anxiety presented to the Emergency Room after being found unresponsive in a hot car. On initial presentation, she was hyperthermic (43.2 °C), hypotensive (48/37 mmHg), with a GCS 3. She was admitted to MICU for shock and acute encephalopathy requiring intubation secondary to heat stroke. In the MICU, she developed delayed multisystem organ failure (MSOF) and lactic acidosis (12.2mg/dL). On day 3, she went into acute liver failure (ALF), evidenced by transaminitis (AST peaked at 5,700IU/L and ALT peaked at 2,663IU/L), ALT:LDH ratio 1.5 indicative of ischemia, hyperammonemia (171µg/dL), total bilirubinemia, prolonged PT, and elevated INR. Her King’s College Criteria was 1. She also had non-oliguric AKI with type 2 troponin elevation. N-acetylcysteine (NAC) was started for ALF. Continuous renal replacement therapy was initiated for hyperammonemia along with lactulose and rifaximin. With these interventions and supportive care, her MSOF and hepatic encephalopathy resolved, prompting successful extubation and discharged to rehabilitation on day 9 after hospitalization. Discussion Identifying risk factors and eliminating causes of heat stroke is imperative. Our patient was on Zonisamide, which has a rare adverse effect of oligohydrosis, impairing thermoregulation. ALF is a rare complication of heat stroke with poor prognosis and may necessitate liver transplant. However, more than 80% of cases improve with medical therapy alone. Liver injury in heat stroke is due to complex processes involving direct cytotoxic heat, inflammatory cytokines, coagulation, and pyroptosis of hepatocytes. In addition to rapid cooling, early initiation of NAC should be considered to increase glutathione and reduce reactive oxygen species aiding in quicker recovery. To date, only a few case reports have shown good outcomes with NAC therapy in heat stroke-induced ALF. Our case highlights the use of NAC in ALF with rapid recovery, warranting further studies. This abstract is funded by: None
Hamed et al. (Fri,) studied this question.