Exertional heat stroke and acute liver failure: a late dysfunction
Open accessAbstract
Heat stroke (HS) is defined as a severe elevation of core body temperature along with central nervous system dysfunction. Exertional heat stroke (EHS) with acute liver failure (ALF) is a rare condition. The authors report the case of a 25-year-old man with a history of cognitive enhancers’ intake who developed hyperthermia and neurological impairment while running an outdoor marathon. The patient was cooled and returned to normal body temperature after 6 h. He subsequently developed ALF and was transferred to the intensive care unit. Over-the-counter drug intake may have been related to heat intolerance and contributed to the event. The patient was successfully treated with conservative measures. In the presence of EHS, it is crucial to act promptly with aggressive total body cooling, in order to prevent progression of the clinical syndrome. Liver function must also be monitored, since it can be a late organ dysfunction.
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EHS is most common in marathons.
“In the latter, it is most common in marathons [14,44,45]”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [45]
EHS can be due to the production of metabolic heat (internal heat) and/or an overload of environmental heat (external heat), and occurs when the thermoregulatory system is disabled due to excessive heat production or inhibition of heat loss (i.e., a decreased sweating response).
“EHS can be due to the production of metabolic heat (internal heat) and/or an overload of environmental heat (external heat), and occurs when the thermoregulatory system is disabled due to excessive heat production or inhibition of heat loss (i.e., a decreased sweating response) [45,61]”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [45]
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Martínez-Sanz, J. M., Fernández Nuñez, A., Sospedra, I., Martínez-Rodríguez, A., Domínguez, R., González-Jurado, J. A., & Sánchez-Oliver, A. J. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17114082 · Cited by 25 · see citing works
- Authors
- Carvalho, A. S., Rodeia, S. C., Silvestre, J., & Póvoa, P.
- Affiliations
- Hospital de Egas Moniz (PT)
- Centro Hospitalar de Lisboa Ocidental (PT)
- Venue
- BMJ Case Reports
- Publisher
- BMJ
- Published
- 2016-03-11
- Volume
- 2016
- Pages
- bcr2016214434
- ISSN
- 1757-790X (ISSN-L)
- PMC
- PMC4800230
- OpenAlex
- W2295655243
- Cited by
- 38
- References
- 16
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 2 · 2023: 4 · 2022: 1 · 2021: 2 · 2020: 6 · 2019: 5 · 2018: 5 · 2017: 1 · 2016: 2
- FWCI
- 3.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ Case Reports (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Universiteit van Amsterdam
- Topics
- Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
- Health Sciences › Medicine › Rehabilitation › Exercise and Physiological Responses
- Health Sciences › Medicine › Surgery › Muscle and Compartmental Disorders
- Keywords
- exertional heat stroke, acute liver failure, hyperthermia, nootropic drugs, over-the-counter medication use, heat intolerance, marathon running, total body cooling, neurological deficit
- MeSH terms
- Adult, Physical Exertion, Fever, Humans, Liver, Male, Running, Liver Failure, Acute, Disease Progression, Nootropic Agents, Heat Stroke
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