Acid-base alterations in heatstroke.
OBJECTIVE
To analyze the acid-base balance during heatstroke.


METHODS
Retrospective study.


METHODS
Heatstroke Center, Makkah, Saudi Arabia.


METHODS
Hundred nine consecutive heatstroke patients (mean age 55 +/- 12 years) with rectal temperature from 40 to 43.4 degrees C following exposure to hot weather.


METHODS
Arterial blood gases collected prospectively and analyzed using 95% confidence limits established by controlled experimental studies. Severity of heatstroke on admission assessed by Simplified Acute Physiology Score and Organ System Failure score.


RESULTS
Metabolic acidosis was the predominant acid-base change followed by respiratory alkalosis (81 and 55% of the patients, respectively). The prevalence of metabolic acidosis (but not respiratory alkalosis) was significantly associated with the degree of hyperthermia: 63, 95 and 100% at 41, 42 and 43 degrees C, respectively (p < 0.0001). Patients with metabolic acidosis had a large anion gap (24 +/- 5). Arterial partial pressure of oxygen (PaO2), systolic blood pressure and Organ System Failure score were similar with or without metabolic acidosis. Although the acute physiology score was higher in patients with, than without, metabolic acidosis (15.7 +/- 3.7 vs 9.8 +/- 4.4, p < 0.001), there was no significant difference in neurologic morbidity and mortality (7.9 vs 1.1%, 5.6 vs 0%, p = 0.776 and 0.581, respectively).


CONCLUSIONS
We conclude that metabolic acidosis is the predominant response in heatstroke.
Bouchama
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Department of Medicine (MBC 46), King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia. abouchama@hotmail.com
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D000137:Acid-Base Imbalance / Q000150:complications* / Q000378:metabolism* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D001831:Body Temperature / Q000502:physiology; D005260:Female; D018883:Heat Stroke / Q000150:complications* / Q000378:metabolism* / Q000503:physiopathology; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index