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A3373 - The Perfect Storm - An Unusual Case of Heat Stroke in a Young Male
Author Block: V. Tiedemann1, H. J. Bachrach1, S. Sahni1, P. S. Gill2, A. Hines3, A. Iftikhar3; 1Department of Primary Care, Touro College of Osteopathic Medicine, Harlem, NY, United States, 2Garden City Sleep Center, Garden City, NY, United States, 3Department of Pulmonary and Critical Care Medicine, New York Presbyterian Queens, Flushing, NY, United States.
Introduction: Non-exertional, or classic heat stroke is a potentially fatal condition characterized by an elevated core body temperature and central nervous system dysfunction. There is a high mortality rate and wide range of complications in patients presenting with classic heat stroke. Diagnosis of heat stroke is complicated by the lack of a specific diagnostic test and vague lab abnormalities which may also indicate other infectious, endocrine, exogenous, or oncologic conditions.
Case Description: A 40-year-old male, with no past medical history, was brought in to the emergency department for altered mental status and a syncopal episode after his first day of work as a truck driver. As per paramedics he was in respiratory distress with tachycardia, which progressed to bradycardia. The patient received Narcan and 1 amp D50 without improvement with initial suspicion of drug abuse. In the emergency department, he was noted to be hyperthermic (39.5C), and had an episode of seizures. The patient was intubated for airway protection and cooling packs were placed. CT scan of head was negative for any bleed or stroke. EKG revealed sinus tachycardia without any ST changes. Patient became hemodynamically unstable and was started on vasopressors. Patient further developed acute renal failure and metabolic acidosis with refractory hyperkalemia (not corrected by the dextrose, insulin and sodium bicarbonate) for which he was started on emergent hemodialysis. His metabolic abnormalities showed slight improvement but clinical course complicated with ischemic colitis and wide complex tachycardia. Wide complex tachycardia treated with amiodarone drip. Patient went to ventricular fibrillation leading to asystole and the patient expired.
Discussion: Traditionally, non-exertional heat stroke is diagnosed in geriatric patients, most frequently in the southern United States during summer months. In a patient with increased core body temperature and central nervous system dysfunction, the diagnosis of heat stroke is supported by arterial blood gases and electrolyte anomalies. Not all patients with heat stroke have an elevated core temperature on presentation, as cooling in the field can decrease core temperature while the metabolic cascade continues to cause systemic damage. Timely diagnosis and emergent treatment of heat stroke is crucial for patient survival. Intervention for non exertional heat stroke is body cooling, with the goal of decreasing the core temperature below 102.2. Our case illustrates a rare presentation of heat stroke in an unsuspecting patient stressing expeditious diagnosis.