title: Successful treatment of a case with acute hepatic failure following hot bath immersion.
abstract: Heat stroke is often complicated by hepatic dysfunction as a manifestation of multiple organ dysfunctions, but acute hepatic failure rarely progresses to become the major morbid condition of heat stroke. We encountered a case who survived life-threatening classic heat stroke; the patient developed this condition, subsequently associated with acute hepatic failure, while bathing at home. A 73-year-old man was found in the bath in his home with unconsciousness, and was transferred to a nearby hospital. At the time he was in a coma, but no remarkable abnormalities were detected on blood examination. Rubor of his entire body beneath the cervical region was recognized. Under the diagnosis of a burn with consciousness disturbance, he was referred and transferred to our hospital. He was comatose and his axillary body temperature was 39.7°C. His consciousness improved after admission, but blood examination revealed rhabdomyolysis, DIC and hepato-renal dysfunction. Subsequent blood examination findings showed rapid exacerbation. On the 2nd hospital day, PT% was 12, INR was 4.8. On the 3rd hospital day, serum ALT was elevated to 3,873 U/L, and the patient had hyperammonemia. On the 13th hospital day, serum total bilirubin was elevated to 33 mg/dl. Thereafter, additional conservative treatment produced gradual recovery of hepatic function.
authors.affiliation: Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan. akieda10@is.icc.u-tokai.ac.jp
authors.forename: Kazuki
authors.initials: K
authors.lastname: Akieda
authors.forename: Rie
authors.initials: R
authors.lastname: Yamamoto
authors.forename: Kozo
authors.initials: K
authors.lastname: Tamura
authors.forename: Seiji
authors.initials: S
authors.lastname: Morita
authors.forename: Mari
authors.initials: M
authors.lastname: Amino
authors.forename: Keiji
authors.initials: K
authors.lastname: Sakurai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Otsuka
authors.forename: Megumi
authors.initials: M
authors.lastname: Motojuku
authors.forename: Sadaki
authors.initials: S
authors.lastname: Inokuchi
mesh_terms: D000368:Aged; D001494:Baths / Q000009:adverse effects*; D018883:Heat Stroke / Q000150:complications* / Q000209:etiology*; D006358:Hot Temperature; D006801:Humans; D007101:Immersion / Q000009:adverse effects*; D017114:Liver Failure, Acute / Q000209:etiology*; D008297:Male