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Rationale:
- These tests are essential for evaluation of the multi-organ dysfunction characteristic of hyperthermic syndromes.
- The hepatic, renal, muscular, and coagulation systems are all heat sensitive and thus strongly affected by heatstroke.
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Evidence:
- A review article showed that elevated body temperature gives rise to a characteristic clinical and pathologic syndrome (8).
- In a review article focusing on the Israeli military, the clinical picture of heatstroke includes elevation of serum enzymes
(9).
- An observational study of 58 patients found that patients with heatstroke experienced multi-organ dysfunction with neurologic
impairment, moderate to severe renal insufficiency, and DIC (16).
- Another observational study showed that the biochemical picture upon admission to the emergency room can be misleading in
the diagnosis of exertional heatstroke (18).
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Comments:
- The laboratory picture of heatstroke is not pathognomonic. Physicians should always consider the clinical picture, especially
core temperature measurement, immediately after the collapse.
- Elevated CPK levels of <1000 IU/L are usually associated with exercise itself.
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Dani Moran, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
James Glazer, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Liran Mendel, BMedSc has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Moshe Rav-Acha, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Darren B. Taichman, MD, PhD, Editor, PIER, has received grant support from Actelion Pharmaceuticals Ltd , and honoraria for
continuing medical education grand rounds and lectures given.
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2010 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Heatstroke
> Diagnosis
