Fulminant liver failure in a street runner: Effects of heat stroke

Castro, Renata Rodrigues Teixeira de; Costa Filho, Rubens; Nóbrega, Antonio Claudio Lucas da

doi:10.1590/1806-9282.64.03.208

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AT THE BEDSIDE • Rev. Assoc. Med. Bras. 64 (3) • Mar 2018 • https://doi.org/10.1590/1806-9282.64.03.208 linkcopy

Fulminant liver failure in a street runner: Effects of heat stroke

Insuficiência hepática fulminante em corredor de rua: efeitos do colapso por calor

Authorship SCIMAGO INSTITUTIONS RANKINGS

We present a clinical case of liver failure induced by heat stroke.

Keywords:
Hepatic Insufficiency; Heat Stroke; Fever

Test	D1	D2	D3	D9
Hemoglobin (g/dL)	11.9	13.2	12.8	11.8
WBC count (n/mm³)	11,000	9,600	7,800	8.9
Platelet count (n/mm³)	138,000	42,000	50,000	203,000
Potassium (mEq/L)	3.6	3.4	3.4	4.3
Sodium (mEq/L)	146	144	142	138
Calcium (g/dL)	9.0		8.5	8.7
Phosphorus (g/dL)			2.2	4.3
Urea (mg/dL)	39	42	21	26
Creatinine (mg/dL)	1.7	1.6	1.3	1.1
CPK (U/L)	278	6,496	10,220	350
Lactate (mmol/L)	5.9	1.9	2.4	1.0
Total bilirubin (mg/dL)		2.5	1.9	1.0
Gamma-glutamyl transferase (U/L)		139	135	113
Glutamic pyruvic transaminase (U/L)	35	2,329	4,985	100
Glutamic oxaloacetic transaminase (U/L)	51	1,596	3,836	120
Alkaline phosphatase (U/L)		82		60
Fibrinogen (U/L)	212			1
Activated partial thromboplastin time (%)	59	18	11	89
INR	1.39	3.67	5.69	1.5
D-dimer (ng/mL)		7,972	8,801
pH urine	5.0	5.0

Stage	Characteristics
Hyperthermic	Neurologic deficit and hyperthermia
Hematologic and enzymatic	Leukocytosis, coagulopathy, increased cellular enzymes
Renal and hepatic impairment	Acute kidney and liver failure

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[TFN1] WBC: white blood cells; CPK: creatine phosphokinase; INR: International Normalized Ratio; D: day of hospitalization.