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A retrospective study of clinical profile and outcomes of critically ill patients with heat-related illness.

Kalaiselvan MS, Renuka MK, Arunkumar AS - Indian J Anaesth (2015)

Bottom Line: HRI often results in Intensive Care Unit (ICU) admissions and are associated with significant morbidity and mortality.However, published report on the effects of HRI among the Indian population is lacking.HRI carries a high mortality and significant neurological morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.

ABSTRACT

Background and aims: Heat-related illness (HRI) due to high ambient temperatures is a common feature during the Indian summer. HRI often results in Intensive Care Unit (ICU) admissions and are associated with significant morbidity and mortality. However, published report on the effects of HRI among the Indian population is lacking. This study was undertaken to identify the profile of patients admitted to ICU with clinical features of HRI and study their clinical outcomes.

Methods: This was a retrospective case series of patients admitted with features of HRI during the summer of 2012 in our multidisciplinary ICU. Data on demographics, co-morbid illness, admission severity of illness (Acute Physiology and Chronic Health Evaluation II [APACHE II]), organ failure scores (Sequential Organ Failure Assessment [SOFA]) and neuroimaging studies were collected. Outcome data studied included mortality, ICU length of stay (LOS), ventilator days and hospital LOS. Statistical analysis was performed using Student's t-test, Chi-square test and multivariate analysis.

Results: Twenty-six patients met the diagnostic criteria for HRI. Fifteen were males. The mean age was 53.12 ± 18.6 years. Mean APACHE II score was 19.6 ± 7.7 and mean SOFA score was 7.5 ± 2.6. The common presenting symptoms were fever with neurological impairment (100%) and gastrointestinal symptoms (30%). Major organ systems involvement include neurological (100%), renal (57%), hepatic (34%) and coagulation abnormalities (26%). Most common metabolic abnormality noted was hyponatraemia (73%). Magnetic resonance imaging findings suggestive of heat stroke were seen in 5 of 26 patients. Mortality rate was 34%. 8 of 17 survivors had residual neurological impairment.

Conclusion: HRI carries a high mortality and significant neurological morbidity.

No MeSH data available.


Related in: MedlinePlus

Serum sodium levels in patients with heat stroke
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Figure 3: Serum sodium levels in patients with heat stroke

Mentions: Seventy-three percentage (19/26) of our patients had hyponatraemia (serum sodium <135 mEq/L) on admission (mean serum sodium 124.38 ± 13.33 mEq/L [±SD]) and most responded to resuscitation with normal saline [Figure 3]. However, hypertonic saline (3%) was used in seven patients who had persistent neurological symptoms (GCS 11.2 ± 1.79, mean ± SD) and hyponatraemia (serum sodium 111 ± 4.0 mEq/L, mean ± SD). Almost 50% of patients had hypokalaemia (serum potassium <3.5 mEq/L) (mean serum potassium 3.5 ± 0.9 mEq/L [±SD]). Creatinine phosphokinase (CPK) levels were elevated in all patients (1856 ± 2372 IU/L, mean ± SD). One patient had CPK levels as high as 92,560 IU/L on admission; this patient had a previous history of heat stroke, had myoglobinuria and renal failure requiring haemodialysis. 15 (57%) patients had elevated serum creatinine; five of these patients had progressively worsening renal function requiring haemodialysis. Liver enzymes were raised in 50%(13/26) patients (aspartate aminotransferase [AST] 198.50 ± 395.6 IU/L and alanine aminotransferase [ALT] 97.5 ± 110 IU/L, mean ± SD) with mildly deranged coagulation profile (International normalised ratio 1.40 ± 0.55) with no obvious bleeding tendencies.


A retrospective study of clinical profile and outcomes of critically ill patients with heat-related illness.

Kalaiselvan MS, Renuka MK, Arunkumar AS - Indian J Anaesth (2015)

Serum sodium levels in patients with heat stroke
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697243&req=5

Figure 3: Serum sodium levels in patients with heat stroke
Mentions: Seventy-three percentage (19/26) of our patients had hyponatraemia (serum sodium <135 mEq/L) on admission (mean serum sodium 124.38 ± 13.33 mEq/L [±SD]) and most responded to resuscitation with normal saline [Figure 3]. However, hypertonic saline (3%) was used in seven patients who had persistent neurological symptoms (GCS 11.2 ± 1.79, mean ± SD) and hyponatraemia (serum sodium 111 ± 4.0 mEq/L, mean ± SD). Almost 50% of patients had hypokalaemia (serum potassium <3.5 mEq/L) (mean serum potassium 3.5 ± 0.9 mEq/L [±SD]). Creatinine phosphokinase (CPK) levels were elevated in all patients (1856 ± 2372 IU/L, mean ± SD). One patient had CPK levels as high as 92,560 IU/L on admission; this patient had a previous history of heat stroke, had myoglobinuria and renal failure requiring haemodialysis. 15 (57%) patients had elevated serum creatinine; five of these patients had progressively worsening renal function requiring haemodialysis. Liver enzymes were raised in 50%(13/26) patients (aspartate aminotransferase [AST] 198.50 ± 395.6 IU/L and alanine aminotransferase [ALT] 97.5 ± 110 IU/L, mean ± SD) with mildly deranged coagulation profile (International normalised ratio 1.40 ± 0.55) with no obvious bleeding tendencies.

Bottom Line: HRI often results in Intensive Care Unit (ICU) admissions and are associated with significant morbidity and mortality.However, published report on the effects of HRI among the Indian population is lacking.HRI carries a high mortality and significant neurological morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.

ABSTRACT

Background and aims: Heat-related illness (HRI) due to high ambient temperatures is a common feature during the Indian summer. HRI often results in Intensive Care Unit (ICU) admissions and are associated with significant morbidity and mortality. However, published report on the effects of HRI among the Indian population is lacking. This study was undertaken to identify the profile of patients admitted to ICU with clinical features of HRI and study their clinical outcomes.

Methods: This was a retrospective case series of patients admitted with features of HRI during the summer of 2012 in our multidisciplinary ICU. Data on demographics, co-morbid illness, admission severity of illness (Acute Physiology and Chronic Health Evaluation II [APACHE II]), organ failure scores (Sequential Organ Failure Assessment [SOFA]) and neuroimaging studies were collected. Outcome data studied included mortality, ICU length of stay (LOS), ventilator days and hospital LOS. Statistical analysis was performed using Student's t-test, Chi-square test and multivariate analysis.

Results: Twenty-six patients met the diagnostic criteria for HRI. Fifteen were males. The mean age was 53.12 ± 18.6 years. Mean APACHE II score was 19.6 ± 7.7 and mean SOFA score was 7.5 ± 2.6. The common presenting symptoms were fever with neurological impairment (100%) and gastrointestinal symptoms (30%). Major organ systems involvement include neurological (100%), renal (57%), hepatic (34%) and coagulation abnormalities (26%). Most common metabolic abnormality noted was hyponatraemia (73%). Magnetic resonance imaging findings suggestive of heat stroke were seen in 5 of 26 patients. Mortality rate was 34%. 8 of 17 survivors had residual neurological impairment.

Conclusion: HRI carries a high mortality and significant neurological morbidity.

No MeSH data available.


Related in: MedlinePlus