Heat Stroke and Pregnancy

A 33-year-old woman participating in a physically high-intensity event experienced a heat injury and was incidentally found to be pregnant. Other contributing factors to the heat injury were the event taking place during the hottest month of the year, consumption of creatine and preworkout supplements, and abstaining from breakfast on the day of the event. She suffered heat stroke with AST and ALTs reaching 8k and CK peak of 36k. The concern for acute liver failure prompted discussions for a possible liver transplant, ultimately not required. Viability of the pregnancy was indeterminable during admission. Follow-up after discharge revealed quadriceps soreness with light activity, CK levels peaking to 5k, and ALT/AST increased to 1062/234 roughly a month after her admission. BUN and Cr were slightly elevated on presentation to ED (23 and 1.8), normalizing with 3L of IVF before admission. UA unremarkable. With continued rest, the patient's symptoms resolved; CK, AST, and ALT normalized; and her pregnancy is proceeding normally. The patient is considered high risk for dehydration, shock liver, and repeat heat injury during her first delivery. This is due to increased CK/AST/ALT levels with moderate walking for 1 h. In addition, the patient meets criteria for heat tolerance testing to determine risk of future heat injuries.