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