title: Out of the frying pan, into the fire: a case of heat shock and its fatal complications.
abstract: Exertional heat stroke incidence is on the rise and has become the third leading cause of death in high school athletes. It is entirely preventable, yet this is a case of a 15-year-old, 97-kg male football player who presented unresponsive and hyperthermic after an August football practice. His blood pressure was 80/30, and his pulse was 180. He had a rectal temperature of 107.3°F, and upon entering the emergency department, he was rapidly cooled in 40 minutes. As he progressed, he developed metabolic acidosis, elevated liver enzymes, a prolapsed mitral valve with elevated troponin levels, and worsening hypotension even with extracorporeal membrane oxygenation support. After 3 days in the hospital, this young man was pronounced dead as a result of complications from exertional heat stroke. We address not only the complications of his hospital course relative to his positive blood cultures but also the complications that can result from attention-deficit/hyperactivity disorder medication our patient was taking. As the population of young adults becomes more obese and more highly medicated for attention-deficit/hyperactivity disorder, we sought out these growing trends in correlation with the increase in incidence of heat-related illness. We also address the predisposing factors that make young high school athletes more likely to experience heat illness and propose further steps to educate this susceptible population.
authors.affiliation: From the Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, University of Louisville, Louisville, KY.
authors.forename: Samantha B
authors.initials: SB
authors.lastname: Allen
authors.forename: Keith P
authors.initials: KP
authors.lastname: Cross
mesh_terms: D000293:Adolescent; D000662:Amphetamines / Q000652:urine; D014151:Anti-Anxiety Agents / Q000652:urine; D001569:Benzodiazepines / Q000652:urine; D001803:Blood Transfusion; D017809:Fatal Outcome; D005538:Football; D018883:Heat Stroke / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008874:Midazolam / Q000652:urine
chemical_list: C090411:Adderall; D000662:Amphetamines; D014151:Anti-Anxiety Agents; D001569:Benzodiazepines; D008874:Midazolam