045 HEAT STROKE WITH ACUTE KIDNEY INJURY AND RHABDOMYOLYSIS: A CASE REPORT

Abstract

Category: Epidemiology and Outcomes from AKI Presenter: Dr AISYA FATHANAH BAHARI Keywords: heat stroke, rhabdomyolysis, acute kidney injury Heatstroke is a medical emergency and severe presentations may present with multiorgan failure. We report a case of with multiple organ dysfunction secondary to heat stroke. A 21-year-old male was brought to the emergency department of the local district hospital after he became unconscious while participating in a multisport event. On arrival, core temperature was 41 degrees Celsius with a Glasgow Coma Scale of 8/15. He was nursed in the Intensive Care Unit (ICU) at a tertiary hospital. Initial cooling and rehydration therapy was started immediately, upon his presentation to a district hospital. He developed seizures and needed ventilator support. A sedative was administered and tracheal intubation was performed. His CT Scan of his Brain was essentially normal. He developed worsening organ dysfunction with severe rhabdomyolysis. He had Acute Kidney Injury Network (AKIN) Stage 3 despite aggressive initial therapy and needed support with Continuous Veno-Veno Hemodialysis (CVVH) on Day 4 of admission. His Creatinine Kinase levels peaked at 31,222 U/L and alaninine transferase (ALT) was at 2782U/L. His CVVH continued for 57 hours, was subsequently able to tolerate intermittent hemodialysis. He was weaned off from dialysis support at Day 13 of admission as he had developed full renal recovery. Patient gradually improved and was extubated on the 24th day of admission. He developed hospital-acquired pneumonia and catheter-related infections; which were addressed with appropriate antibiotic therapy. Upon discharge at Day 35, patient was well without any neurological sequele. His serum creatinine on discharge was 82 umol/L. Rhabdomyolysis and acute kidney injury (AKI) is a common presentation in severe heatstroke. Acute kidney injury due to heatstroke was worsened by concomitant rhabdomyolysis and systemic inflammatory response syndrome. Etiology is multifactorial, includes direct thermal injury, rhamdomyolysis, disseminated intravascular complications and renal hypo-perfusion due to depleted volume. Severe heatstroke can cause profound AKI. Physicians should be able to identify and treat heatstroke to avoid complications and reduce mortality and morbidity.