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Severe liver failure in exertional heat stroke
T Giercksky1, K M Boberg, I N Farstad
1Medical Dept. A, Rikshospitalet, Oslo, Norway.
Scandinavian Journal of Gastroenterology
|September 28, 1999
Summary
Exertional heat stroke can occur even in temperate climates, leading to severe liver damage. This liver injury may be reversible with conservative treatment, questioning the need for liver transplantation.
Area of Science:
- Medicine
- Hepatology
- Sports Medicine
Background:
- Exertional heat stroke (EHS) typically occurs in warm climates.
- Elevated liver enzymes are common in EHS, but severe liver failure is rare and has a poor prognosis.
- Liver transplantation is considered for severe liver failure in EHS, though long-term survival data is limited.
Observation:
- A 31-year-old male experienced heat stroke after a 5 km run in 21°C weather.
- He developed severe liver damage, with alanine aminotransferase (ALAT) levels reaching 16,410 U/l and significant coagulation disturbance (Normotest 12%, INR 4.2).
- Liver biopsy revealed extensive liver cell necrosis.
Findings:
- The patient recovered completely with conservative treatment, despite initial consideration for liver transplantation.
- This case demonstrates that exertional heat stroke is a diagnostic consideration even in temperate climates.
- Severe liver failure in EHS can be reversible, challenging established treatment protocols.
Implications:
- Clinicians should consider exertional heat stroke in patients presenting with severe liver injury, regardless of climate.
- The reversibility of liver damage suggests conservative management may be effective, potentially avoiding liver transplantation.
- Further research is needed to clarify the indications for liver transplantation in exertional heat stroke-induced liver failure.