A case of heatstroke complicated with SIRS successfully treated with hemodiafiltration

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  • ＳＩＲＳを呈した熱射病の血液濾過透析による救命治療の１例
  • ショウレイ ホウコク SIRS オ テイシタ ネッシャビョウ ノ ケツエキ ロカ トウセキ ニ ヨル キュウメイ チリョウ ノ 1レイ

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Abstract

Mortality due to heatstroke has been reported to be attributable to the host's inflammatory response to severe heat stress, suggesting that immunomodulation treatment may improve fatal outcome. We report a case of heatstroke complicated with SIRS (systemic inflammatory response syndrome) successfully treated with hemodiafiltration (HDF). A 19-year-old Japanese male, Japan Ground Self-Defense Forces official, was brought to our hospital by ambulance following disturbance of consciousness and the drift of the legs during outdoor training under the blazing heat exceeding WBGT (wet-bulb globe temperature) 29.9°C. At hospitalization, blood pressure was 90/60mmHg and body temperature 40.2°C, 160 pulse rates per minute, regular, and WBC 14, 800 per mm3 with marked immature blastoid cells. The patient was diagnosed as having heatstroke complicated with SIRS and shock. Additionally, abnormally high levels of serum IL-6 and IL-10 were recognized. Initially, the patient was treated with body surface cooling and a large volume of hydration, but he was not stabilized. Then, he was given HDF treatment for three consecutive hours and improved dramatically thereafter. Using HDF, we could overcome hyperthermia in a relatively short period of time, then achieved effective restoration of altered cell function and partly the removal of cytokines, in the early stage of the disease. We postulate that HDF treatment is a useful lifesaving cure in severe heatstroke complicated with SIRS via core cooling effect and favorable immunomodulation.

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