Wang A Y, Li P K, Lui S F, Lai K N
Department of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital Shatin.
Ren Fail. 1995 Mar;17(2):171-9. doi: 10.3109/08860229509026254.
We report a fatal case of heatstroke in an obese boy who developed multi-organ failure. Six other cases of exertional heatstroke admitted to our hospital over the last 5 years were also reviewed. All of them showed some degree of renal impairment. The causes of renal failure are multifactorial, with rhabdomyolysis being the major mechanism. All cases except one responded to alkaline diuresis without the need for dialysis. Continuous venovenous hemofiltration appeared to be a good alternative in hemodynamically unstable patients. Renal function recovered completely after varying intervals in all surviving cases. Interestingly, rhabdomyolysis in our heatstroke patients was usually associated with hypokalemia or normokalemia instead of hyperkalemia. Mortality in our series was largely related to the long duration of hyperthermia and coma, the severity of disseminated intravascular coagulation, and the presence of cardiogenic shock and severe acidosis.
我们报告了一例肥胖男孩中暑致死的病例，该男孩出现了多器官功能衰竭。我们还回顾了过去5年我院收治的另外6例劳力性中暑病例。所有这些病例均表现出一定程度的肾功能损害。肾衰竭的原因是多因素的，横纹肌溶解是主要机制。除1例病例外，所有病例对碱性利尿治疗均有反应，无需透析。连续性静脉-静脉血液滤过似乎是血流动力学不稳定患者的良好替代治疗方法。所有存活病例的肾功能在不同间隔后完全恢复。有趣的是，我们中暑患者的横纹肌溶解通常与低钾血症或血钾正常有关，而非高钾血症。我们系列病例中的死亡率在很大程度上与高热和昏迷持续时间、弥散性血管内凝血的严重程度以及心源性休克和严重酸中毒的存在有关。
