Lethal Heat Shock with disseminated intravascular Coagulopathy

We report on a case of severe heat stroke due to extended exposure to the sun in an enclosed glass cabin of an agricultural vehicle. Patient treatment, lab results and complications are reported and we examine the current literature on heat stroke. Heat stroke is a very rare and highly severe condition mostly suffered by vulnerable individuals or individuals exposed to extreme physical strain. Per definition a heat stroke is characterized by neurological deficit (especially loss of consciousness), and a high body temperature. Most important treatment is to lower the body temperature below 40 degrees C as quickly as possible. The best method is cold water immersion, but there are several other physical and invasive means that can be used. If performed within 30 minutes after the beginning of the incident this treatment decreases mortality considerably. Heat damage affects every organ and organ system. Most important are neurologic deficits, cardiovascular failure, liver failure and kidney failure. The excessive heat triggers a systemic inflammatory response syndrome (SIRS) which can lead to a disseminated intravascular coagulopathy (DIC). Haemostasis is also directly affected by the elevated temperature. Besides physical cooling, there is no known specific treatment to prevent secondary damage from heat stroke. Additionally, supportive care and ICU monitoring should be applied.