Successful conservative management of fulminant hepatic failure following exertional heatstroke

DOI 18 References
  • Yonemitsu Koichiro
    National Hospital Organization Osaka National Hospital Critical Care Medical Center Division of Emergency & Critical Care Medicine, Kumamoto University Hospital
  • Haku Kousei
    National Hospital Organization Osaka National Hospital Critical Care Medical Center
  • Maeno Yoshito
    National Hospital Organization Osaka National Hospital Critical Care Medical Center
  • Ohnishi Mitsuo
    National Hospital Organization Osaka National Hospital Critical Care Medical Center
  • Nishino Masato
    National Hospital Organization Osaka National Hospital Critical Care Medical Center
  • Yoshihiro Kinoshita
    Division of Emergency & Critical Care Medicine, Kumamoto University Hospital
  • Sadamitsu Daikai
    National Hospital Organization Osaka National Hospital Critical Care Medical Center

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  • 劇症肝不全を合併した熱中症ＩＩＩ度症候群の一救命例

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We herein report the case of a 39-year-old male who presented with fulminant hepatic failure following exertional heatstroke induced after running 8 km. His temperature was 40.9°C. Acute hepatic failure occurred 3 days later and the patient thereafter fell into a hepatic coma, with a prothronbin level of 20%, aspartate aminotransferase (AST) of 3,330 IU/l, and alanine aminotransferase (ALT) of 5,880 IU/l, hepaplastin test of 20%, arterial ketone body ratio (AKBR) 0.69, and NH3 155μg/dl on day 4. We performed plasma exchange (PE), followed by continuous hemodiafiltration (CHDF). The patient thereafter completely recovered while receiving conservative treatment. Severe hepatic failure due to exertional heatstroke typically occurs 3 days after onset and it tends to recover under conservative treatment. An early detailed evaluation of the liver is considered to be essential for the successful clinical management of patients presenting with exertional heatstroke.

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