title: Antithrombin and near-fatal exertional heat stroke.
abstract: Heat waves result in excess deaths, excess emergency department visits, and intensive care unit admissions for heat stroke. We describe the clinical features and 3-month outcome of a patient with near-fatal heat stroke, admitted to our intensive care unit in July, 2001. After heavily working for hours at a construction site during a heat wave, the 28-year-old male presented with 41.4 degrees C body temperature and multiorgan failure, consisting of neurological impairment, rhabdomyolysis, acute renal failure, disseminated intravascular coagulation, and acute respiratory distress syndrome (ARDS). In the first week there was no evidence of infection. Treatment included cooling, aggressive volume resuscitation, administration of antithrombin-III concentrates and steroids. The patient survived and recovered normal neurological, renal, respiratory and haematological function, and no disability persisted. This case illustrates survival and complete recovery after multiorgan failure in heat stroke with vigorous intensive care. Treatment with antithrombin and steroids and may well have contributed to the favourable outcome. Correction of reduced antithrombin III levels to supranormal by therapeutic administration of antithrombin III concentrate in disseminated intravascular coagulation of heat stroke was not associated with any bleeding complications.
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck. Christoph.Pechlaner@uibk.ac.at
authors.forename: Ch
authors.initials: Ch
authors.lastname: Pechlaner
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Kaneider
authors.forename: Angela
authors.initials: A
authors.lastname: Djanani
authors.forename: A
authors.initials: A
authors.lastname: Sandhofer
authors.forename: P
authors.initials: P
authors.lastname: Schratzberger
authors.forename: J R
authors.initials: JR
authors.lastname: Patsch
mesh_terms: D000328:Adult; D000990:Antithrombin III / Q000627:therapeutic use*; D001831:Body Temperature; D018883:Heat Stroke / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D005082:Physical Exertion / Q000502:physiology*; D016896:Treatment Outcome
chemical_list: D000990:Antithrombin III