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The Metabolic and Respiratory Alterations of Heat Stroke

The Metabolic and Respiratory Alterations of Heat Stroke Abstract • The metabolic and respiratory changes of 21 patients with heat stroke were studied. Admission arterial blood gas levels were measured, and serum bicarbonate, lactate, calcium, phosphorus, and anion gap determinations were performed. Seven patients had a metabolic acidosis (pH 7.20 ± 0.04, Pco2 32 ± 2 mm Hg, and bicarbonate 12 ± 1 mEq/L), seven a combined metabolic acidosis and respiratory alkalosis (pH 7.39 ± 0.01, Pco2 25 ± 1 mm Hg, and bicarbonate 15 ± 1 mEq/L), four a respiratory alkalosis (pH 7.45 ± 0.01, Pco2 30 ± 1 mm Hg, and bicarbonate 20 ± 1 mEq/L), one a metabolic and respiratory acidosis (pH 7.13, Pco2 52 mm Hg, and bicarbonate 17 mEq/L), and one a respiratory acidosis (pH 7.30, Pco2 56 mm Hg, and bicarbonate 27 mEq/L). The 15 patients with a metabolic acidosis had a pH of 7.28 ± 0.03, Pco2 of 30 ± 2 mm Hg, bicarbonate level of 14 ± 1 mEq/L, lactate concentration of 6.5 ± 1.0 mEq/ L, and an anion gap of 26 ± 4 mEq/L. Nine patients were hypocalcemic (7.8 ± 0.3 mg/dL), and five patients were hypophosphatemic (2.0 ± 0.2 mg/dL). The predominant metabolic change in heat stroke is a metabolic acidosis secondary to increased lactate content and/or a respiratory alkalosis. Hypocalcemia is common and hypophosphatemia is not infrequent. (Arch Intern Med 140:665-669, 1980) References 1. Sprung CL: The hemodynamic alterations of heat stroke in the elderly. Chest 75:362-366, 1979.Crossref 2. O'Donnell TF Jr: Acute heat stroke: Epidemiologic, biochemical, renal and coagulation studies. JAMA 234:824-838, 1975.Crossref 3. Kew MC, Bersohn I, Seftel H, et al: Liver damage in heat stroke. Am J Med 49:192-202, 1970.Crossref 4. Costrini AM, Pitt HA, Gustafson AB, et al: Cardiovascular and metabolic manifestations of heat stroke and severe heat exhaustion. Am J Med 66:296-302, 1979.Crossref 5. Austin MG, Berry JW: Observations on 100 cases of heat stroke. JAMA 161:1525-1529, 1956.Crossref 6. Hall WW, Wakefield EG: A study of experimental heat stroke. JAMA 89:177-182, 1927.Crossref 7. Knochel JP, Caskey JH: The mechanism of hypophosphatemia in acute heat stroke. JAMA 238:425-426, 1977.Crossref 8. Mason J, Thomas E: Rhabdomyolysis from heat hyperpyrexia. JAMA 235:633-634, 1976.Crossref 9. Knochel JP: Environmental heat illness. Arch Intern Med 133:841-864, 1974.Crossref 10. Ruppert RD, Newman A, Scarpelli DG, et al: The mechanism of metabolic acidosis in heat stroke, abstracted. Clin Res 12:356, 1964. 11. Siggaard-Andersen 0: Blood acid-base alignment nomogram. Scand J Clin Lab Invest 15:211-217, 1963.Crossref 12. Severinghaus JW: Blood gas calculator. J Appl Physiol 21:1108-1116, 1966. 13. Bradley AF, Stupfel M, Severinghaus JW: Effect of temperature on Pco. and Po2 of blood in vitro. J Appl Physiol 9:201-204, 1956. 14. Varley H: Practical Clinical Biochemistry . New York, W. Heinemann Medical Books Ltd, 1967, p 618. 15. Clowes GHA, O'Donnell TF Jr: Heat stroke. N Engl J Med 291:564-567, 1974.Crossref 16. Gaudio R Jr, Abramson N: Heat-induced hyperventilation. J Appl Physiol 25:742-746, 1968. 17. Boyd AE, Beller GA: Heat exhaustion and respiratory alkalosis. Ann Intern Med 83:835, 1975.Crossref 18. Oliva PB: Lactic acidosis. Am J Med 48:209-225, 1970.Crossref 19. Knochel JP: The pathophysiology and clinical characteristics of severe hypophosphatemia. Arch Intern Med 137:203-220, 1977.Crossref 20. O'Conner LR, Wheeler WS, Bethune JE: Effect of hypophosphatemia on myocardial performance in man. N Engl J Med 297:901-903, 1977.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1980 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1980.00330170081028
Publisher site
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Abstract

Abstract • The metabolic and respiratory changes of 21 patients with heat stroke were studied. Admission arterial blood gas levels were measured, and serum bicarbonate, lactate, calcium, phosphorus, and anion gap determinations were performed. Seven patients had a metabolic acidosis (pH 7.20 ± 0.04, Pco2 32 ± 2 mm Hg, and bicarbonate 12 ± 1 mEq/L), seven a combined metabolic acidosis and respiratory alkalosis (pH 7.39 ± 0.01, Pco2 25 ± 1 mm Hg, and bicarbonate 15 ± 1 mEq/L), four a respiratory alkalosis (pH 7.45 ± 0.01, Pco2 30 ± 1 mm Hg, and bicarbonate 20 ± 1 mEq/L), one a metabolic and respiratory acidosis (pH 7.13, Pco2 52 mm Hg, and bicarbonate 17 mEq/L), and one a respiratory acidosis (pH 7.30, Pco2 56 mm Hg, and bicarbonate 27 mEq/L). The 15 patients with a metabolic acidosis had a pH of 7.28 ± 0.03, Pco2 of 30 ± 2 mm Hg, bicarbonate level of 14 ± 1 mEq/L, lactate concentration of 6.5 ± 1.0 mEq/ L, and an anion gap of 26 ± 4 mEq/L. Nine patients were hypocalcemic (7.8 ± 0.3 mg/dL), and five patients were hypophosphatemic (2.0 ± 0.2 mg/dL). The predominant metabolic change in heat stroke is a metabolic acidosis secondary to increased lactate content and/or a respiratory alkalosis. Hypocalcemia is common and hypophosphatemia is not infrequent. (Arch Intern Med 140:665-669, 1980) References 1. Sprung CL: The hemodynamic alterations of heat stroke in the elderly. Chest 75:362-366, 1979.Crossref 2. O'Donnell TF Jr: Acute heat stroke: Epidemiologic, biochemical, renal and coagulation studies. JAMA 234:824-838, 1975.Crossref 3. Kew MC, Bersohn I, Seftel H, et al: Liver damage in heat stroke. Am J Med 49:192-202, 1970.Crossref 4. Costrini AM, Pitt HA, Gustafson AB, et al: Cardiovascular and metabolic manifestations of heat stroke and severe heat exhaustion. Am J Med 66:296-302, 1979.Crossref 5. Austin MG, Berry JW: Observations on 100 cases of heat stroke. JAMA 161:1525-1529, 1956.Crossref 6. Hall WW, Wakefield EG: A study of experimental heat stroke. JAMA 89:177-182, 1927.Crossref 7. Knochel JP, Caskey JH: The mechanism of hypophosphatemia in acute heat stroke. JAMA 238:425-426, 1977.Crossref 8. Mason J, Thomas E: Rhabdomyolysis from heat hyperpyrexia. JAMA 235:633-634, 1976.Crossref 9. Knochel JP: Environmental heat illness. Arch Intern Med 133:841-864, 1974.Crossref 10. Ruppert RD, Newman A, Scarpelli DG, et al: The mechanism of metabolic acidosis in heat stroke, abstracted. Clin Res 12:356, 1964. 11. Siggaard-Andersen 0: Blood acid-base alignment nomogram. Scand J Clin Lab Invest 15:211-217, 1963.Crossref 12. Severinghaus JW: Blood gas calculator. J Appl Physiol 21:1108-1116, 1966. 13. Bradley AF, Stupfel M, Severinghaus JW: Effect of temperature on Pco. and Po2 of blood in vitro. J Appl Physiol 9:201-204, 1956. 14. Varley H: Practical Clinical Biochemistry . New York, W. Heinemann Medical Books Ltd, 1967, p 618. 15. Clowes GHA, O'Donnell TF Jr: Heat stroke. N Engl J Med 291:564-567, 1974.Crossref 16. Gaudio R Jr, Abramson N: Heat-induced hyperventilation. J Appl Physiol 25:742-746, 1968. 17. Boyd AE, Beller GA: Heat exhaustion and respiratory alkalosis. Ann Intern Med 83:835, 1975.Crossref 18. Oliva PB: Lactic acidosis. Am J Med 48:209-225, 1970.Crossref 19. Knochel JP: The pathophysiology and clinical characteristics of severe hypophosphatemia. Arch Intern Med 137:203-220, 1977.Crossref 20. O'Conner LR, Wheeler WS, Bethune JE: Effect of hypophosphatemia on myocardial performance in man. N Engl J Med 297:901-903, 1977.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1980

References