title: Multiple organ failure caused by non-exertional heat stroke after bathing in a hot spring.
abstract: Heat stroke is a life-threatening illness, and the disease spectrum can include the involvement of multiple organs to varying degrees. Rhabdomyolysis with renal function impairment is frequently noted in this disease. However, acute hepatic failure has been rarely reported in non-exertional heat stroke. We report a case of acute hepatic failure combined with disseminated intravascular coagulopathy, acute renal failure, and neurological deficit caused by heat stroke after bathing in a hot spring. Molecular adsorbent recirculating system (MARS) treatment was performed daily on days 10-12 of admission. As a result of progressive azotemia, hemodialysis was performed. Unfortunately, after a long course of intensive care, the patient died from septic shock and multiple organ failure. According to available evidence, MARS and hemodialysis are beneficial in treating exertional heat stroke. However, a limited number of studies have treated non-exertional heat-stroke-related acute hepatic failure. Early cooling to reduce the overwhelming heat-stress-related cytokine storm, and advanced MARS to eliminate circulating toxin might have a role in treating this rare but fatal illness.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Lee
authors.forename: Chin-Lin
authors.initials: CL
authors.lastname: Perng
authors.forename: Yi-Shin
authors.initials: YS
authors.lastname: Huang
authors.forename: Jiing-Chyuan
authors.initials: JC
authors.lastname: Luo
authors.forename: Chi-Lai
authors.initials: CL
authors.lastname: Hung
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
mesh_terms: D001494:Baths; D003956:Dialysis; D017809:Fatal Outcome; D018883:Heat Stroke / Q000150:complications*; D045482:Hot Springs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology* / Q000628:therapy; D012772:Shock, Septic / Q000209:etiology