Sindhoora Adyanthaya
North Alabama Medical Center
Florence, Alabama
Disclosure information not submitted.
Ishita Mehra, MD, MBBS, MD
Resident Physician
North Alabama Medical Center
Florence, Alabama
Disclosure information not submitted.
Sucheta Kundu, MD
North Alabama Medical Center
Florence, Alabama
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Brigette Thomas, MD
Resident Physician
North Alabama Medical Center, United States
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Kamini Rao, MD
Resident Physician
North Alabama Medical Center, United States
Disclosure information not submitted.
Jan Westerman, MD
Doctor
Pulmonary & Sleep Associates of Jasper, PC, United States
Disclosure information not submitted.
Title: Heat Injury - Heat Stroke, Is Ice the Cause?
Introduction: Classic heat stroke (HS) is defined as core body temperature of > 40 C after prolonged heat exposure without exertion. Its prevalence in cooler countries is limited to extreme heatwaves affecting the elderly. Several prescribed medications & many illicit drugs are known to interfere with thermoregulatory mechanisms. We report a case of a middle-aged male who presented with severe classic HS in the setting of methamphetamine use.
Description: A 47-year-old male became unresponsive in a parked car with ignition off & windows closed. He was found anxious, rocking & sweating. The outside temperature was around 31 C. He had no co-morbidities & no home medication. He smoked, vaped, binged on alcohol, & had a remote history of polysubstance use. On arrival, he was hypotensive, hyperthermic (42.2 C/107.9F), tachycardic, tachypneic & diaphoretic with pinpoint pupils. He rapidly deteriorated & arrested with pulseless electrical activity. He was intubated & resuscitated with return of spontaneous circulation in 9 minutes. He was treated with evaporative & convective methods of cooling & admitted to the ICU with initiation of targeted temperature management (36 C), IV fluids, pressors & bicarbonate drip. Initial labs showed respiratory & metabolic acidosis with a pH of 7.13, PCO2 64.6, lactic acid 21.2, CPK 4543, WBC 33.8, creatinine 2.4, transaminitis, and INR 1.2. Urine toxicology revealed methamphetamine & marijuana. CT head showed cerebral edema. His steady deterioration led to multi-organ failure with disseminated intravascular coagulation. 16 hours later he experienced refractory hypotension despite 4 pressor & recurrent episodes of cardiac arrest. In view of his poor prognosis, the patient was transitioned to DNR & succumbed to his acute insult.
Discussion: Methamphetamine increases body temperature by promoting heat generation & suppressing physiologic responses that facilitate heat dissipation. HS results from environmental exposure in at-risk people. In both, extremes of temperature result in uncoupling of oxidative phosphorylation causing cellular anoxia. Reduction of morbidity & mortality is related to early, rapid cooling. Rising prevalence in the use of methamphetamine should prompt awareness & lead to improved training of EMS & ER personnel on cooling methods which should be initiated in the field.