What are potential complications of heat stroke?

Updated: Aug 02, 2019
  • Author: Robert S Helman, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Heat stroke is a multisystem insult that potentially can affect almost every organ system.

The central nervous system (CNS) is especially sensitive to the damaging effects of hyperthermia. Widespread cell death occurs but is more evident in the region of the cerebellum (Purkinje cells). Heat stroke–related long-term CNS sequelae include cerebellar deficits, dementia, hemiplegia, quadriparesis, and personality changes.

In one study, rhabdomyolysis was observed in almost all patients with EHS and in as many as 86% of patients with NEHS. Compartment syndrome is observed most commonly in patients with severe rhabdomyolysis and in patients who are immobilized.

Acute kidney injury may occur in as many as 25-30% of patients who have heat stroke (especially EHS).

Acute liver failure due to centrilobular hepatic necrosis and cholestasis generally occurs in the first 48 hours, but it can peak as long as 2 weeks after the onset of heat stroke. In rare instances, liver failure may be complicated by a fulminant course requiring liver transplantation. Patients who survive generally have a complete return of hepatic function.

DIC is a rare complication and caries a poor prognosis when it occurs. Electron microscopy studies have shown that direct thermal injury to the vascular endothelium is the primary trigger of platelet aggregation and, possibly, DIC.

ARDS may be due to direct thermal injury to the lung, or it may complicate liver failure, infection, or aspiration. When associated with liver failure, the patient's prognosis is much worse.

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