Therapeutic plasma exchange in the treatment of exertional heat stroke and multiorgan failure
- First Online:
- 540 Downloads
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.
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.
KeywordsTherapeutic plasma exchange Heat stroke Continuous renal replacement therapy
- 3.Horseman MA, Rather-Conally J, Saavedra C, Surani S (2012) A case of severe heatstroke and review of pathophysiology, clinical presentation, and treatment. J Intensive Care Med. doi:10.1177/0885066611434000
- 4.Misset B, De Jonghe B, Bastuji-Garin S, Gattolliat O, Boughrara E, Annane D, Hausfater P, Garrouste-Orgeas M, Carlet J (2006) Mortality of patients with heatstroke admitted to intensive care units during the 2003 heat wave in France: a national multiple-center risk-factor study. Crit Care Med 34:1087–1092PubMedCrossRefGoogle Scholar
- 8.Knochel JP, Reed G (1994) Disorders of heat regulation. In: Narins RG (ed) Maxwell and Kleemans clinical disorder of fluid and electrolyte metabolism. McGraw-Hill, New York, pp 1549–1590Google Scholar
- 15.Nguyen TC, Han YY, Kiss JE, Hall MW, Hassett AC, Jaffe R, Orr RA, Janosky J, Caracillo JA (2008) Intensive plasma exchange increases a disintegrin and metalloprotease with thrombospondin motifs-13 activity and reverses organ dysfunction in children with thrombocytopenia-associated multiple organ failure. Crit Care Med 36:2878–2887PubMedCrossRefGoogle Scholar
- 18.Ikeda Y, Sakemi T, Nishihara G, Nakamura M, Fujisaki T, Koh T, Tomiyoshi Y, Emura S, Taki K (1999) Efficacy of blood purification therapy for heat stroke presenting rapid progress of multiple organ dysfunction syndrome: a comparison of five cases. Intensive Care Med 25:315–318PubMedCrossRefGoogle Scholar