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Pediatric Nephrology

, Volume 28, Issue 6, pp 971–974 | Cite as

Therapeutic plasma exchange in the treatment of exertional heat stroke and multiorgan failure

  • Vimal Master Sankar Raj
  • Amanda Alladin
  • Brent Pfeiffer
  • Chryso Katsoufis
  • Marissa Defreitas
  • Alicia Edwards-Richards
  • Jayanthi Chandar
  • Wacharee Seeherunvong
  • Gwenn McLaughlin
  • Gaston Zilleruelo
  • Carolyn L. Abitbol
Brief Report

Abstract

Background

Exertional heat stroke (EHS) results in a constellation of systemic inflammatory responses resulting in multiorgan failure and an extremely high mortality.

Case Diagnosis and Treatments

We present the case of an 11-year-old obese male who suffered EHS with rhabdomyolysis and concurrent renal, pulmonary, and hepatic failure. Conventional therapies including continuous veno-venous hemodiafiltration (CVVHDF) were ineffective in preventing ongoing deterioration in clinical status. Liver biopsy was reported as “extensive hepatocyte ballooning” and liver-kidney transplantation was tentatively planned.

Conclusions

The addition of therapeutic plasma exchange using the Prismaflex® system (Gambro, Lakewood, CO, USA) resulted in a reversal of the inflammatory process and recovery from multiorgan failure. Liver biopsy was not a reliable indicator of irreversible hepatic injury.

Keywords

Therapeutic plasma exchange Heat stroke Continuous renal replacement therapy 

Notes

Acknowledgments

The authors wish to thank the nurses in the Pediatric Dialysis Unit and the Pediatric Intensive Care Unit for their work and devotion to patient care. We also appreciate the support of Mr. Steven Burghart of the Administration at Holtz Children’s Hospital.

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Copyright information

© IPNA 2013

Authors and Affiliations

  • Vimal Master Sankar Raj
    • 1
    • 2
  • Amanda Alladin
    • 2
  • Brent Pfeiffer
    • 3
  • Chryso Katsoufis
    • 1
  • Marissa Defreitas
    • 1
    • 2
  • Alicia Edwards-Richards
    • 1
    • 2
  • Jayanthi Chandar
    • 1
  • Wacharee Seeherunvong
    • 1
  • Gwenn McLaughlin
    • 3
  • Gaston Zilleruelo
    • 1
  • Carolyn L. Abitbol
    • 1
  1. 1.Department of Pediatrics, Division of Pediatric Nephrology (R-714)University of Miami/Holtz Children’s Hospital at Jackson Health SystemMiamiUSA
  2. 2.Pediatric Postgraduate Training ProgramUniversity of Miami/Holtz Children’s Hospital at Jackson Health SystemMiamiUSA
  3. 3.Pediatric Critical Care MedicineUniversity of Miami/Holtz Children’s Hospital at Jackson Health SystemMiamiUSA

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