1/9. liver failure occurring as a component of exertional heatstroke.An unusual case of an exertional heatstroke in a healthy 25-year-old man is presented. Initially, the patient was deeply comatose and developed severe rhabdomyolysis and massive hepatic necrosis. Subsequently, he received a liver transplant with remarkable improvement in his mental status, although the rhabdomyolysis continued. The patient died 41 days after the transplant due to a complicating infection. Providing that infections can be effectively controlled, liver transplants might be a promising therapeutic alternative for the few patients who survive the initial neurological consequences of this unusual event.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/9. Haemorrhagic shock encephalopathy.Three children suffered from acute onset of convulsions and progressive coma associated with hyperpyrexia, profound shock and generalized bleeding tendency. No causative agent could be identified. Despite aggressive resuscitation they all died. Post-mortem examination revealed cerebral oedema, petechial haemorrhages of the gut, lungs and kidneys, and a generalized depletion of lymphocytes in the lymphoid organs. Features were compatible with haemorrhagic shock encephalopathy, which is a highly fatal disease. The possible role of hyperpyrexia in its pathophysiology is discussed. More careful case identification and research in various possible aetiological factors may help elucidate its pathogenesis.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
3/9. Multi-organ damage in exertional heat stroke.Exertion-induced heat stroke is a relatively rare disorder in the moderate maritime climate of The netherlands. Serious complications of excessive physical activity rarely occur. We describe a marathon runner with multi-organ failure after exertion-induced heat stroke. The patient developed shock, diarrhoea, coma, rhabdomyolysis, acute renal failure, liver cell damage and disseminated intravascular coagulation but recovered completely.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
4/9. The golden hour in heat stroke: use of iced peritoneal lavage.A case of heat stroke is described in which the patient presented comatose with a rectal temperature exceeding 42.5 degrees C. Standard external evaporative cooling and iced gastric lavage failed to alter his temperature or mental status. Iced peritoneal lavage brought about a decrease in rectal temperature to 39.4 degrees C and significant improvement in mental status. The patient recovered uneventfully. Techniques of rapid cooling are discussed.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
5/9. neuroleptic malignant syndrome.We present the case of a 35-year-old man who developed symptoms of the neuroleptic malignant syndrome (NMS) after taking prescribed, moderately high, therapeutic doses of haloperidol. When brought to the emergency department, he was comatose, hypotensive, and had rigid muscle tone and a core body temperature of 42.2 C. Although initial treatment was supportive, intubation, ventilator support, and further care in the intensive care unit were necessary. Ensuing disseminated intravascular coagulation was treated successfully and the patient was weaned from the ventilator on the third day after admission. He was discharged from the hospital 11 days after admission. Recently recognized drug therapy for NMS, such as bromocriptine mesylate and dantrolene sodium, was not used in this case.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
6/9. Fatal heatstroke after a short march at night: a case report.A case of heatstroke is reported in a young recruit who participated in a 4-km march at night. body temperature was not measured at the time of collapse. hyperventilation and aggressive behavior misled to the incorrect diagnosis of hysteric reaction. Upon arrival at the Medical Center 4h later, the patient experienced deep coma, renal failure, shock, and uncontrolled bleeding. Inspite of intensive treatment, the patient died 27 h after collapse. A positive blood culture suggests the involvement of septicemia in the fulminant picture of the disease. The importance of immediate measurement of rectal temperature in any case of collapse after exercise is emphasized.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
7/9. survival in a heat stroke victim with a core temperature in excess of 46.5 C.Presented is a case report of a 52-year-old male heat stroke victim. The patient presented in deep coma with a temperature above 42 C. Following rapid assessment, the patient was intubated, rehydration was begun, and he was externally cooled with ice bags and internally cooled with ice water gastric lavage. After 25 minutes the patient's core temperature was measured at 46.5 C (115.7 F). Multiple organ system failure developed over the ensuing days. With aggressive care, the patient improved dramatically and was discharged at prior baseline status on the 24th day of hospitalization. This case now represents the highest human body temperature elevation reported without permanent residua.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
8/9. Renal failure and heatstroke.We report a fatal case of heatstroke in an obese boy who developed multi-organ failure. Six other cases of exertional heatstroke admitted to our hospital over the last 5 years were also reviewed. All of them showed some degree of renal impairment. The causes of renal failure are multifactorial, with rhabdomyolysis being the major mechanism. All cases except one responded to alkaline diuresis without the need for dialysis. Continuous venovenous hemofiltration appeared to be a good alternative in hemodynamically unstable patients. Renal function recovered completely after varying intervals in all surviving cases. Interestingly, rhabdomyolysis in our heatstroke patients was usually associated with hypokalemia or normokalemia instead of hyperkalemia. mortality in our series was largely related to the long duration of hyperthermia and coma, the severity of disseminated intravascular coagulation, and the presence of cardiogenic shock and severe acidosis.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
9/9. Epidemic heat stroke in a midwest community: risk factors, neurological complications and sequelae.We studied the admission rate, risk factors, neurological complications and sequelae of heat stroke (HS) during the 1995 heat wave in Madison, wisconsin. HS was epidemic in 1995 (2.3 cases/1000 admissions), compared to the ten-fold lower endemic rate in 1994 (0.2/ 1000). There were 11 cases of HS, 9 males and 2 females. Contributing factors were athletic events (2), working outdoors (3) and indoor activity with malfunctioning air-conditioning (6). Medical conditions contributing to poor temperature regulation included schizophrenia with neuroleptic treatment (2), amyotrophic lateral sclerosis receiving nortriptiline (1), multiple sclerosis (1), attention deficit disorder (1), cystic fibrosis (1) and alcoholism (1). Acute neurological complications occurred in all patients on presentation including coma (8/11.73%), stupor (2/ 11.18%) and seizures (1/11.9%). Two patients (1856) had persistent neurological sequelae in the form of a pan-cerebellar syndrome while the remaining 9 recovered fully. Importantly, avoidable factors contributed to all of the patients with underlying diseases. These patients are particularly at risk and should take adequate precautions during summer months.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |