Coup de chaleur d’exercice, il y a urgence à refroidir

Abstract

Exertional-induced heatstroke is characterized by a core temperature above 40°C, with neurological symptoms following physical exercise. Observed during intense exercise or in difficult environmental conditions, its incidence is difficult to assess due to its rarity. Its complex physiopathology involved mainly thermal dysregulation, with dysregulated excessive heat production due to exercise. Hyperthermia can trigger a systemic inflammatory reaction which can lead to multi-visceral failure, impairing the patient’s prognosis.When encountering neurological symptoms during physical activity, it is essential to consider the possibility of a diagnosis, which can be confirmed by assessing core body temperature. The primary intervention involves stopping physical activity and initiating rapid cooling through immersion in cold water. If the patient progresses to multi-visceral failure, the first few hours may be marked by hemodynamic instability, rhabdomyolysis, disseminated intravascular coagulation (DIC), renal failure, and liver failure, which may require liver transplantation. Assessing the need for liver transplantation can be a challenge, as DIC and neurological disturbances associated with exercise-induced heat stroke might bias the assessment of hepatic failure.This review discusses the epidemiology and mechanisms of exercise-induced heat stroke. It outlines diagnostic aspects, initial management, and intensive care while highlighting the challenges of transplantation and relevant decision-making criteria.