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Exertional heat stroke and acute liver failure: a late dysfunction
  1. Ana Sofia Carvalho1,
  2. Simão C Rodeia2,
  3. Joana Silvestre1,
  4. Pedro Póvoa1
  1. 1Polyvalent Intensive Care Unit, Hospital São Francisco Xavier—Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
  2. 2Internal Medicine Department, Hospital Egas Moniz—Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
  1. Correspondence to Dr Ana Sofia Valente Cardoso Dias Carvalho, asofia.dc{at}


Heat stroke (HS) is defined as a severe elevation of core body temperature along with central nervous system dysfunction. Exertional heat stroke (EHS) with acute liver failure (ALF) is a rare condition. The authors report the case of a 25-year-old man with a history of cognitive enhancers’ intake who developed hyperthermia and neurological impairment while running an outdoor marathon. The patient was cooled and returned to normal body temperature after 6 h. He subsequently developed ALF and was transferred to the intensive care unit. Over-the-counter drug intake may have been related to heat intolerance and contributed to the event. The patient was successfully treated with conservative measures. In the presence of EHS, it is crucial to act promptly with aggressive total body cooling, in order to prevent progression of the clinical syndrome. Liver function must also be monitored, since it can be a late organ dysfunction.

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