Heat stroke is a life-threatening condition that requires immediate medical attention. It is characterised by a body temperature exceeding 40°C, along with neurological dysfunction. Heat stroke can lead to multiple organ failure, including acute kidney injury (AKI) and chronic kidney disease (CKD). The risk of AKI in heat stroke patients is often associated with rhabdomyolysis, a condition where muscle cell contents leak into the circulation, leading to elevated creatine kinase (CK) levels. In addition, heat stroke can cause dehydration, which further contributes to kidney damage. The treatment for heat stroke focuses on rapid cooling and rehydration, as the duration of hyperthermia is a critical factor in determining patient outcomes.
Characteristics | Values |
---|---|
Can heat stroke cause kidney failure? | Yes |
What is the mechanism? | Rhabdomyolysis, dehydration, direct thermal injury, disseminated intravascular coagulation, and renal hypoperfusion due to volume depletion and arterial hypotension |
What are the risk factors for heat illness? | Very young, very old, obesity, alcohol abuse, psychiatric drugs, heart disease, medication that causes dehydration, living in an enclosed environment without cooling |
How to prevent heat illness? | Take special precautions for those with risk factors, provide access to cooling measures, avoid diuretics and alcohol, provide plenty of liquids and ice |
What to do if you suspect heat illness? | Get the person to a cooler environment, activate emergency services, use fan, ice or cooling mist, do not offer oral liquids if the person is unconscious or poorly responsive |
What You'll Learn
Heat stroke and rhabdomyolysis
Heat stroke is the most severe heat-related illness, with a body temperature of over 40°C combined with neurologic dysfunction. It is a type of severe heat illness with life-threatening injury requiring emergent and intensive care. Heat stroke can lead to multi-organ failure, including acute kidney injury.
Rhabdomyolysis is a major mechanism leading to acute kidney injury in patients with heat stroke. The risk of AKI in rhabdomyolysis is usually low when creatine kinase levels on admission are less than 20,000 U/L. However, AKI is still a risk when creatine kinase levels are as low as 5,000 U/L when other coexisting conditions occur, such as sepsis, severe dehydration, and acidosis.
The classic presentation of rhabdomyolysis includes myalgias, limb weakness, and pigmenturia due to myoglobinuria without hematuria. AKI is a potential complication of severe rhabdomyolysis, accounting for 8-15% of all cases of AKI in the US. The mortality rate of heat stroke can be as high as 70%, especially when treatment is delayed and when multiple organ failure is present.
The severity and complications of exertional heat stroke correlate with the temperature duration curve, suggesting that a rapid reduction in the core temperature by any cooling method as early as possible should have a positive effect on prognosis.
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Heat stroke and acute kidney injury
Heat stroke is a medical emergency and a leading cause of preventable death in sports. It is characterised by a body temperature of over 40°C, combined with neurologic dysfunction. Heat stroke can lead to acute kidney injury (AKI) in several ways.
Firstly, heat stroke can cause rhabdomyolysis, which is the breakdown of skeletal muscle cells. This releases myoglobin into the bloodstream, which can build up in the kidneys and cause AKI. Rhabdomyolysis is often associated with exertional heat stroke, particularly in hot and humid conditions.
Secondly, heat stroke can cause dehydration, which leads to low blood pressure and decreased kidney function. Dehydration is more likely in hot environments and can be exacerbated by diarrhoea, vomiting, and the use of diuretics.
Thirdly, heat stroke can cause hypotension and shock, which can reduce blood flow to the kidneys and result in acute tubular necrosis, leading to AKI.
Finally, heat stroke can cause disseminated intravascular coagulation (DIC), which can lead to acute respiratory distress syndrome (ARDS). ARDS can, in turn, cause pulmonary oedema and respiratory failure, compromising oxygen delivery to the kidneys.
The treatment for heat stroke-induced AKI includes aggressive cooling measures, such as ice baths, and intravenous rehydration. In severe cases, renal replacement therapy such as hemodialysis may be required.
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Heat stroke treatment and management
Heat stroke is a medical emergency and a leading cause of preventable death in sports. The treatment and management of heat stroke involve several critical steps, including:
Initial Assessment and Cooling:
- Once heat stroke is suspected, cooling must be initiated immediately, ideally at the scene before transporting the patient to the hospital.
- Removing restrictive clothing, spraying water on the body, using ice water-soaked sheets, or applying ice packs to the axillae and groin can help reduce body temperature.
- Intubation may be necessary for patients unable to protect their airway, while supplemental oxygen should be provided to awake and responsive individuals.
- Rectal temperature measurements are preferred for accurately obtaining core body temperatures.
- Evaporative cooling is the most effective method in the field and involves spraying the patient's skin with a cool water mist while fanning warm air over the body.
- Immersion cooling methods, such as ice baths or ice packs, are also used but may cause peripheral vasoconstriction and shivering if the skin temperature drops below 30°C.
Medical Care and Monitoring:
- Intravenous lines may be placed for fluid resuscitation and the infusion of dextrose and thiamine.
- Hypoglycemia is common in patients with exertional heat stroke and may indicate liver failure, so the infusion of dextrose 50% in water solution (D50W) should be considered.
- Continuous monitoring of vital signs, including temperature, airway, circulation, and urine output, is crucial.
- Insertion of a nasogastric tube to monitor for gastrointestinal bleeding and fluid losses, as well as a Foley catheter to monitor urine output and/or body temperature, may be necessary.
- The goal is to reduce the temperature by at least 0.2°C/min to approximately 39°C to avoid overshooting and rebound hyperthermia.
Pharmacological Management:
- Antipyretics (e.g., acetaminophen, aspirin) are not recommended as they interrupt the hypothalamic set point and may aggravate bleeding tendencies in patients with hepatic, hematologic, and renal complications.
- Benzodiazepines are indicated for patients with agitation and shivering to stop excessive heat production and are the sedatives of choice for patients with delirium or withdrawals.
- Barbiturates may be used for patients with convulsions refractory to benzodiazepines.
- Intravenous fluids are administered to correct hypovolemia, with guidance from hemodynamic parameters such as central venous pressure and cardiac index measurements.
- Treatment of rhabdomyolysis involves large volumes of intravenous fluids, alkalinization of urine, and mannitol infusion to prevent renal failure.
- Hepatic failure treatment includes dextrose solutions to correct hypoglycemia, early recognition and treatment of disseminated intravascular coagulation, and meticulous respiratory support.
- Acute kidney injury may require hemodialysis if renal failure occurs.
Prevention and Community Intervention:
- Prevention is key, and community intervention programs can help decrease morbidity and mortality associated with heat stroke.
- Education about maintaining hydration, avoiding heat exposure, wearing appropriate clothing, and monitoring exertion levels is essential.
- Athletes should undergo acclimatization before exerting themselves in hot conditions.
- Heat shelters, early warning systems, and public awareness campaigns can help vulnerable individuals protect themselves during heat waves.
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Heat stroke risk factors
Heat stroke is a severe heat-related illness characterised by a body temperature of over 40°C, combined with neurologic dysfunction. It is a medical emergency and can be fatal. The risk factors for heat stroke include:
- Age: Infants and the very young are more susceptible to heat stroke as they have a higher surface area to mass ratio and will absorb heat from the environment more readily. They are also unable to remove themselves from warm environments. Teenage athletes are also very prone to heat stroke, especially during summer training for sports such as soccer and football.
- Environment: Individuals who live in areas with high temperatures and high humidity are at greater risk of heat stroke.
- Lifestyle: Obesity and alcohol abuse are frequent risk factors for heat stroke.
- Medication: Certain medications, such as psychiatric drugs and diuretics, can increase the risk of heat stroke by affecting the body's ability to regulate temperature and causing dehydration.
- Cardiovascular health: Individuals with heart disease or hypertension are at greater risk of heat stroke as these conditions can affect the body's ability to regulate temperature and blood flow.
- Physical fitness: Poor physical fitness can be a risk factor, particularly when combined with other factors such as hot and humid conditions and hypokalemia.
- Enclosed spaces: Being in an enclosed, unventilated, or poorly cooled space can increase the risk of heat stroke.
- Outdoor work or exercise: Strenuous physical activity or work in hot environments can lead to heat stroke, especially if proper hydration and cooling measures are not taken.
- Clothing: Wearing restrictive clothing that does not allow the body to cool down can increase the risk of heat stroke.
- Dehydration: Dehydration can impair the body's ability to regulate temperature and can lead to heat stroke.
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Heat stroke prevention
Heat stroke is a severe heat-related illness that can be life-threatening. It is characterized by a body temperature of over 40°C, along with neurological dysfunction. Heat stroke can lead to multiple organ failure, including acute kidney injury, and has a high mortality rate, especially when treatment is delayed. Therefore, it is crucial to take preventive measures to avoid heat stroke, especially during hot weather. Here are some essential heat stroke prevention tips:
- Stay in a Cool Environment: Whenever possible, stay in an air-conditioned place to keep your body cool. If your home doesn't have air conditioning, spend time in shopping malls, public libraries, or designated heat-relief shelters.
- Choose Appropriate Clothing: Wear lightweight, loose-fitting clothes. Avoid excess clothing or tight-fitting outfits that can hinder your body's ability to cool down.
- Stay Hydrated: Drink plenty of fluids, even if you don't feel thirsty. Avoid sugary, alcoholic, and very cold drinks, as they can be counterproductive. If you're on medication or have specific health conditions, consult your doctor about your fluid intake.
- Protect Yourself from the Sun: Wear a wide-brimmed hat and sunglasses when outdoors. Use sunscreen with an SPF of at least 30, and reapply it every two hours or more frequently if you're swimming or sweating.
- Adjust Your Meals: Avoid hot and heavy meals, as they add heat to your body.
- Be Cautious with Exercise: Cut down on strenuous exercise during hot weather, especially if you're not accustomed to it. If you must exercise, do it during the coolest parts of the day, such as early morning or evening, and rest frequently in shady areas.
- Be Mindful of Certain Medications: Some medications can affect your body's ability to stay hydrated and regulate temperature. Consult your healthcare provider to understand the potential impact of your medications and take any necessary precautions.
- Avoid Staying in Parked Cars: Never leave anyone, especially children, in a parked car, even with the windows cracked open. The temperature inside a car can rise rapidly, posing a significant risk of heat stroke or even death.
- Be Extra Cautious with Certain Groups: Infants, young children, the elderly, people with certain medical conditions, and those who are overweight are at higher risk of heat-related illnesses. Take extra precautions with these vulnerable groups and monitor them closely during hot weather.
By following these preventive measures, you can significantly reduce the risk of heat stroke and its potentially severe consequences, including kidney failure.
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Frequently asked questions
Yes, heat stroke can cause kidney failure. Heat stroke can lead to acute kidney injury (AKI) due to rhabdomyolysis, which is a syndrome characterised by the leakage of muscle-cell contents into the circulation. Rhabdomyolysis can be caused by strenuous exercise and is the most common cause of kidney failure in cases of heat stroke.
The clinical characteristics of heat illness are commonly seen when the body temperature approaches 104 degrees Fahrenheit and when humidity is greater than 70%. Symptoms include loss of sweating, confusion leading to coma, fast pulse, low blood pressure, heart failure and kidney failure.
If you suspect someone has heat stroke, it is important to get them to a cooler environment and activate emergency services. You should also use external cooling methods such as fans, ice, and cool compresses. Do not offer oral liquids if the person is unconscious or poorly responsive, as this could induce aspiration and pneumonia.
Infants, the elderly, teenage athletes, and people with obesity or alcohol abuse issues are at a higher risk of developing heat illness. It is important to be aware of these risk factors and take precautions, such as ensuring access to cooling measures and providing plenty of liquids and ice.
Body temperatures exceeding 104 degrees Fahrenheit can cause significant problems for the kidneys, including dehydration, low blood pressure, and decreased kidney function. Heat illness can also lead to a breakdown of muscle tissue that results in kidney failure.