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Abstract: A 43-year-old male developed headache, nausea, vomiting, followed by unconsciousness and convulsions after working in a hot environment in direct sunlight for 6 hours. On admission, the patient was in a state of hyperthermia, confusion, irritability, and paroxysmal spasms of the lower extremities. After completing the relevant examinations, the preliminary diagnosis was considered heat stroke, which was a heat stroke. The patient’s condition gradually improved after treatment related to cooling, rehydration, volume expansion, and protection of multiple organs was given.
Basic information】Male, 43 years old
Type of disease】Heatstroke
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】August 2021
Treatment plan】Medication (diazepam tablet + 0.9% sodium chloride injection + 5% glucose injection + methylprednisolone tablet + mannitol injection + fructose injection + vitamin C tablet + glutathione tablet + edaravone injection + esomeprazole enteric capsule + potassium chloride injection + magnesium sulfate injection) + physical therapy (ice bag, ice cap)
Treatment period】5 days of hospitalization
Treatment effect】The condition has been controlled, and all indicators are improving
I. Initial consultation
After working for 6 hours in a hot environment under direct sunlight, the patient developed headache, nausea, vomiting and other symptoms, which were not taken seriously. When we received the patient, he was unconscious, irritable, hyperthermic, with a body temperature of 40.1°C, no sweating around the body, and paroxysmal spasms of both lower limbs. Blood pressure was immediately monitored at 100/60 mmHg, heart rate was 118 beats/min, bilateral pupil size and light reflex were normal, there was no obvious resistance in the neck, no clear pathological signs, and no significant abnormalities were seen in the head CT. These initially suggested that it was unlikely that the patient had neurological diseases such as acute cerebral hemorrhage, cerebral infarction or encephalitis. The patient was previously healthy, did not drink a lot of alcohol and other bad habits, had a history of long working hours in a hot environment, combined with the patient’s symptoms and biochemical examination results ALT: 584 U/L, AST: 2480 U/L, GGT: 587 U/L, TBIL: 35.4 μmol/L, DBIL: 27.2 μmol/L, BUN: 13.39 mmol/L, and Crea: 248μmol/L, CK: 1391U/L, LDH: 1555U/L, K: 2.4mmol/L, Ca: 1.91mmol/L, Mg: 0.6mmol/L, CK-MB: 5.5ug/L, routine blood results: white blood cells 2.3×10^9, platelets 27×10^9, we initially considered the patient to be heatstroke with a high possibility of pyrexia.
II. Treatment history
Considering that the patient was the most critical type of heat stroke, which has a very high mortality rate, we immediately communicated with the family about the condition and asked them to be psychologically prepared. In terms of treatment, we considered that the patient’s high fever might be related to the abnormal function of the thermoregulatory center due to direct sunlight, and quickly used ice blankets and ice caps to assist in cooling, gave diazepam tablets to sedate the patient for restlessness, opened intravenous access, quickly replenished 0.9% sodium chloride injection and 5% glucose injection to rapidly rehydrate and expand the volume to maintain normal tissue and organ perfusion, and used intravenous methylprednisolone tablets to antagonize the heat-induced The body’s stress reaction caused by high temperature is antagonized by intravenous methylprednisolone tablets; the body is dehydrated, cranial pressure is lowered and cerebral edema is prevented by rapid sedative mannitol injection; the heart muscle is nourished by fructose injection and vitamin C tablets; the liver and kidney is protected by glutathione tablets; the brain is protected by edaravone injection; the gastric mucosal damage caused by stress is prevented by esomeprazole enteric capsule; the upper gastrointestinal bleeding caused by stress ulcer is prevented; the electrolytes such as potassium chloride injection and magnesium sulfate injection are supplemented according to the ionization test results. Magnesium sulfate injection and other electrolytes to correct electrolyte disorders.
III. Treatment effect
After rapid expansion, rehydration and physical cooling such as ice bag and ice cap, the patient’s body temperature gradually decreased and consciousness gradually recovered. The urine volume gradually returned to normal after intravenous rehydration of about 4,000 ml, and creatinine once rose to 500 μmol/L, then gradually decreased. After 2 days of intravenous potassium supplementation, the blood potassium was basically stabilized at normal level. At the time of admission, due to muscle twitching, liver, kidney and myocardial injury, various muscle enzymes were significantly elevated. After 3 days of organ protection treatment and hormone administration, the indexes decreased significantly at the time of re-examination, but the patient’s skin mucosa gradually appeared yellowish, and the biliary MRI was perfected and stones were found in the low bile duct. At the 5th day of hospitalization, he was rechecked with routine blood tests: WBC 4.2×10^9, platelets 77×10^9, biochemistry: ALT: 101U/L, AST: 710U/L, GGT: 211U/L, TBIL: 110.1μmol/L, DBIL: 89.1μmol/L, Crea: 284μmol/L, CK: 117 U/L, LDH: 532U/L, K: 3.5 mmol/L, Ca: 2.06 mmol/L, Mg: 1.04 mmol/L, CK-MB: 2.7ug/L. The patient’s status improved significantly, and with the 5th day of hospitalization, the family strongly requested to be discharged.
IV. Notes
I am glad that the patient’s symptoms have improved after treatment. Since the patient’s current hospitalization is still short, although he has seen improvement, his condition has not fully recovered and is not suitable for discharge, while in the case of the family’s strong request for discharge, the following suggestions can be given.
1, try to choose the hospital to continue to give multi-organ drug therapy until the platelets return to normal, liver function, kidney function fully recovered.
2. Considering that the patient has stones in the low bile duct and currently has yellow staining of the skin and mucous membranes and increased bilirubin, it is suggested that after the basic recovery of the condition, further treatment in the gastroenterology department should be chosen at an optional date.
3. It is recommended to pay attention to avoid direct light on the head when working in the future, which may cause high brain tissue temperature and thus trigger pyrexia again.
4.When working in a hot environment, we should strengthen our own protection, such as wearing a hat, light-colored and loose clothes, and taking more electrolyte-rich drinks during work.
V. Personal insight
Heat stroke, also known as heat stroke, has a very high mortality rate. Once the disease is initially diagnosed, it should be treated promptly. The summer heat period in the northeast is very short, and the temperature is usually not very high, so the occurrence of heat stroke is not common, and people rarely pay attention to the problem of heat stroke in production work. In recent years, as the temperature rises, the number of patients suffering from heat stroke gradually increases, so it is necessary to expand the popularization of science, pay attention to heat stroke prevention and ventilation when working and working in high-temperature conditions, drink more drinks containing potassium, magnesium and calcium salts to prevent heat stroke, and wear loose, breathable light-colored clothes. For the elderly and frail, people with chronic diseases and pregnant women, the living environment should be ventilated, while these people should not engage in high-temperature work.