Golpe de calor: a propósito de un caso clínico / Heat stroke. a case report

El golpe de calor es una entidad poco frecuente y subdiagnosticada. La elevación de la temperatura corporal es la que desencadena las disfunciones metabólicas que pueden incluso llevar a la muerte. Se presenta el caso de un militar que se encontraba realizando ejercicios de infantería, durante el mes de septiembre, en días donde se produjeron condiciones climáticas extremas y desarrolla un cuadro de Disfunción Orgánica Múltiple (DOM) primaria; fue llevado al Servicio de Emergencia del Hospital de Fray Bentos, Río Negro. La evolución inicial se caracterizó por deterioro de la función neurológica, respiratoria, necesidad de ventilación mecánica, falla renal aguda y disfunción hematológica; se establecieron los diagnósticos de golpe de calor, injuria renal, rabomiólisis, insuficiencia respiratoria aguda y coagulación intravascular diseminada (CID). A pesar del tratamiento y manejo de sostén tiene una mala evolución, falleciendo a las 48 horas del ingreso. El caso nos recuerda que la exposición a condiciones de calor por arriba de la temperatura corporal, deteriora los mecanismos de control de calor corporal y metabólico. Es necesario un diagnóstico rápido y un manejo de sostén para conseguir una evolución satisfactoria.

A heat stroke is a very rare and under diagnosed entity. The rise in the body’s temperature is the element that triggers the metabolic dysfunctions that can even lead to death. A case of a soldier is presented; this soldier was training, doing his infantry exercises routine, during September, in days were extreme climate situations were happening, installing a case of primary Multiple Organ Dysfunction (MOD) syndrome. The soldier was taken to the Emergency Service in Fray Bentos’ Hospital, in Rio Negro. The initial evolution was clumsy and slowly, and the neurologic and breathing functions were worsening, with acute renal failure, and also hematological dysfunction. In addition to this, the patient was in need of mechanic ventilation. The diagnosis of temperature shock, acute renal injury, Rhabdomyolysis, acute respiratory failure and disseminated intravascular coagulation (DIC) were established. Supportive care was given to the patient, with an un satisfactory development, leading to death 48 hours after the hospital admission. This case reminds us that, the exposure to weather conditions that are over the body temperature interferes in the metabolism and the body’s mechanisms for controlling heat. A quick diagnosis and supportive care are needed in order to achieve a satisfactory evolution.

Role of PPARβ in fibroblast response to heat injury.

Peroxisome proliferator-activated receptors (PPARs) belong to the nuclear hormone receptor family of ligand-inducible transcription factors. Our previous study has shown that in human umbilical vein endothelial cells PPARβ initiates a protective mechanism that limits the extent of damage due to H2O2-induced injury. Although fibroblasts are one of the main cell types involved in wound repair, the role of PPARβ in the fibroblast response to heat injury has not been investigated. Thus, in this study, we examined possible protective role of PPARβ in fibroblasts from heat injury. We developed a novel dermal fibroblast heat injury model to characterize the mechanisms of the heat injury healing response that involved PPARβ. The specific PPARβ ligand GW0742, a PPARβ activator and a short hairpin RNA (shRNA) plasmid against PPARβ were used to reveal the action mechanism of PPARβ in heat injury-induced fibroblast changes in morphology and increased proliferation. In response to heat injury (52˚C for 30 s), fibroblast activation of PPARß, increased 1.56-fold. Administration of GW0742 significantly induced a protective effect on heat injury-induced fibroblasts by minimizing the structural damage and increasing the cell proliferation response. Likewise, inhinition of PPARß, usingh shRNA exacerbated the damage by inhibiting the de novo synthesis of PPARß. These results indicated that heat injury enhanced PPARß expression and PPARß protected fibroblast structure and proliferation.

Heat stroke victims in Sukkur city of Sindh - Pakistan

This is a descriptive, cross-sectional study, conducted on 14 cases of heat stroke and hyperpy-rexia admitted in Civil Hospital, Sukhur between 1st Jan. and 31st Dec, 2006. The objective was to evaluate the clinical presentation, socio-demographic pattern and to suggest preventive strategies for the control of this problem. Data analysis showed mean age was 32.86 with S.D. +/- 17.06. 85.7 were males and 14.37 females, making a male to female ratio of 6:1 occupation wise, date showed 7.17, house wives, 28.47, labourers, 43.9% farmers and 21.4% were children. With proper and efficient management the cure rate was 100%. Study concluded that the lives of the victims of heat stroke and hyperpyrexia could be saved with proper preventive measures, first aid programmes and efficient treatment practices

study of 76 cases of heat stroke at J.P.M.C, Karachi

Heat stroke is the most severe among heat illnesses. People at risk are military personnel, sportsmen, labourers, alcoholics and patients on major tranqailizers. In June 1996, 76 patients were admitted in Medical Unit-III, Jinnah Postgraduate Medical Centre, Karachi with the clinical diagnosis of heat stroke. Of 76 patients 56 recovered, while 20 expired. Mortality rate was 26.31 percent. Clinical presentation like stroke, grade-IV coma and DIC were associated with high mortality. Old age, hypertension, diabetes mellitus and IHD were major risk factors of heat stroke mortality. Quick medical help and treatment of associated diseases decreased mortality

Muerte súbita en atletas y golpe de calor: la importancia de un diagnóstico precoz / Sudden death in the athletes and heat stroke: the importance of a prompt diagnosis

Un joven de 25 años sin enfermedades previas conocidas, se colapsa durante un medio maratón en el mes de diciembre (temperatura ambiente 36§C). Luego de su admisión presentó hipertermia central, arritmia ventricular compleja, deterioro neurológico, rabdomiolisis, anuria y coagulación intravascular diseminada, falleciendo en el término de pocos minutos. La muerte súbita en el atleta plantea un desafío desde el punto de vista médico como social. Las enfermedades que la causan se suelen agrupar de acuerdo con su prevalencia -dada por la edad del sujeto-, siendo notoria en muchas casuísticas la ausencia de una entidad potencialmente letal (pero rápidamente reversible) como es el golpe de calor. Este es un cuadro de instalación súbita, debido a una gran producción de calor y a la dificultad para su disipación. Si ambas condiciones persisten, se genera fallo multiorgánico y finalmente colapso cardiovascular. La importancia del diagnóstico precoz se evidencia en que la normalización rápida de la temperatura central elimina dichas complicaciones, mientras que la demora en reconocer el cuadro puede producir secuelas graves o incluso la muerte del sujeto. En la discusión se exponen las diferencias con el golpe de calor clásico y las medidas que deben adoptarse (tanto médicas como generales) para modificar la evolución natural de esta entidad.

Management of heat stroke in 304 patients during hajypilgri mage

Three hundred and four patients with different degrees of heatstroke were treated by the Hajj medical team of the Islamic Republic of Iran. Four percent of the patients had associated diseases. A simple method using immersion in iced tap water was used for management of heatstroke. Advantages and wide applicability of the technique are described, achieving good results without using sophisticated and expensive means