Abstract
Heat stroke has been known since biblical times, and muscular exertion haslong been recognized as a precipitating factor. However, muscle has seldom been examined histologically in heat stroke. The authors have studied two patients who collapsed after strenuous exertion on a sultry summer day, and were treated by repeated dialyses for oliguria and refractory hyperkalaemia. One died after five days and the other recovered. Skeletal muscles examined at necropsy from the first patient and by biopsy from the second, all showed necrosis of many fibres and central vacuolation of others. Although muscle necrosis has been noticed in only nine of the many cases of heat stroke in the English medical literature, the frequency of renal failure with so-called 'haemoglobinuric' nephrosis suggests that rhabdomyolysis is a common occurrence. We consider that it may be an important cause of systemic disturbances and especially of serum potassium alterations in exertional heat stroke.
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