Therapeutic plasma exchange in the treatment of exertional heat stroke and multiorgan failure

Background.Exertional heat stroke is a life-threatening condition often complicated by multiorgan failure. We hereby present a case of a 25-year-old male presenting with syncope after a 10 km run in 28°C outside temperature who developed acute liver failure. Case Presentation. Initial temperature was found to be 41.1°C, and cooling measures were rapidly applied. He suffered from acute renal failure and rhabdomyolysis and proceeded to acute liver failure (ASAT 6100 U/l and ALAT 6561 U/l) due to hypoxic hepatitis on day 3. He did not meet criteria for emergency liver transplantation and recovered on supportive care. Conclusions. Acute liver failure due to heat stroke is a life-threatening condition with often delayed onset, which nevertheless resolves on supportive care in the majority of cases; thus, a delayed referral to transplant seems to be reasonable.

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1423: THERAPEUTIC PLASMA EXCHANGE FOR THROMBOCYTOPENIA-ASSOCIATED MULTIORGAN FAILURE IN SEPTIC SHOCK

Critical Care Medicine ◽

10.1097/01.ccm.0000529425.30564.64 ◽

2018 ◽

Vol 46 (1) ◽

pp. 695-695

Author(s):

Philip Keith ◽

Lauren Eyadiel ◽

Jeremy Hodges ◽

Karen Sands ◽

Jared Watkins

Keyword(s):

Septic Shock ◽

Plasma Exchange ◽

Multiorgan Failure ◽

Therapeutic Plasma Exchange

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The Fire from Within: Multiorgan Failure with Bimodal Rhabdomyolysis from Exertional Heat Stroke

Case Reports in Hepatology ◽

10.1155/2020/1305730 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Onion Gerald V. Ubaldo ◽

Khia Quiwa ◽

Rohana Elise Rollan ◽

Edhel Tripon ◽

Elizabeth Sebastian

Keyword(s):

Liver Transplantation ◽

Liver Failure ◽

Liver Transplant ◽

Core Body Temperature ◽

Multiorgan Failure ◽

Heat Stroke ◽

Exertional Heat Stroke ◽

Liver Support ◽

Central Nervous System Dysfunction ◽

Extracorporeal Liver Support

Heat stroke (HS) is a condition characterized by a rise in core body temperature and central nervous system dysfunction. It is divided into two types: classical and exertional. Exertional heat stroke (EHS) is accompanied by organ failure. Liver injury, presenting only with a rise in liver enzymes, is common but in rare conditions, acute liver failure (ALF) may ensue, leading to a potentially lethal condition. Most cases of EHS-induced ALF are managed conservatively. However, liver transplantation is considered for cases refractory to supportive treatment. Identifying patients eligible for liver transplantation in the context of an EHS-induced ALF becomes a medical dilemma since the conventional prognostic criterion may be difficult to apply, and there is paucity of literature about these specific sets of individuals. Recently, extracorporeal liver support has been gaining popularity for patients with liver failure as a bridge to liver transplant. In this case report, we present a young Filipino athlete with symptoms and clinical course consistent with EHS that developed multiorgan failure, initially considered a candidate for liver transplant and total plasma exchange, but clinically improved with supportive management alone. This patient was also found to have bimodal rhabdomyolysis during the course of his hospital stay as manifested by the bimodal rise in his creatine kinase enzymes.

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High-volume plasma exchange in a patient with acute liver failure due to non-exertional heat stroke in a sauna

Journal of Clinical Apheresis ◽

10.1002/jca.21315 ◽

2014 ◽

Vol 29 (5) ◽

pp. 281-283 ◽

Cited By ~ 10

Author(s):

Kuan-Jung Chen ◽

Tso-Hsiao Chen ◽

Yuh-Mou Sue ◽

Tzay-Jinn Chen ◽

Chung-Yi Cheng

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Plasma Exchange ◽

Heat Stroke ◽

High Volume ◽

Exertional Heat Stroke

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A Case of Exertional Heat Stroke with Acute Hepatic Failure Treated with Plasma Exchange - A Case Report -

The Korean Journal of Critical Care Medicine ◽

10.4266/kjccm.2012.27.2.130 ◽

2012 ◽

Vol 27 (2) ◽

pp. 130 ◽

Cited By ~ 1

Author(s):

Young Joo Han ◽

Jae Wook Choi ◽

Woo Jin Chung ◽

Dong In Suh ◽

June Dong Park

Keyword(s):

Case Report ◽

Plasma Exchange ◽

Hepatic Failure ◽

Heat Stroke ◽

Acute Hepatic Failure ◽

Exertional Heat Stroke

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Case series supporting heme detoxification via therapeutic plasma exchange in acute multiorgan failure syndrome resistant to red blood cell exchange in sickle cell disease

Transfusion ◽

10.1111/trf.14407 ◽

2017 ◽

Vol 58 (2) ◽

pp. 470-479 ◽

Cited By ~ 8

Author(s):

James E. Louie ◽

Caitlin J. Anderson ◽

Katayoun Fayaz M. Fomani ◽

Alonye Henry ◽

Trevor Killeen ◽

...

Keyword(s):

Sickle Cell Disease ◽

Blood Cell ◽

Plasma Exchange ◽

Sickle Cell ◽

Red Blood Cell ◽

Multiorgan Failure ◽

Case Series ◽

Therapeutic Plasma Exchange ◽

Cell Disease

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Protective Effects of Salidroside on Mitochondrial Functions against Exertional Heat Stroke-Induced Organ Damage in the Rat

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2015/504567 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 9

Author(s):

Wei Zhang ◽

Ming Peng ◽

Yang Yang ◽

Zhangwu Xiao ◽

Bin Song ◽

...

Keyword(s):

Inflammatory Responses ◽

Multiorgan Failure ◽

Heat Stroke ◽

Organ Damage ◽

Peroxisome Proliferator ◽

Mrna Levels ◽

Protective Effects ◽

Exertional Heat Stroke ◽

Peroxisome Proliferator Activated Receptor ◽

Mitochondrial Functions

Exertional heat stroke (EHS) results in a constellation of systemic inflammatory responses resulting in multiorgan failure and an extremely high mortality. The present study was designed to evaluate the protective effects of salidroside on EHS by improving mitochondrial functions in the rat model. Liver and heart mitochondria were observed by transmission electron microscopy and mitochondrial membrane potential (ΔΨm) was detected by a fluorescent probe. Intramitochondrial free Ca2+concentration, mitochondrial respiratory control ratio (RCR), reactive oxygen species (ROS) levels, superoxide dismutase (SOD), and malondialdehyde (MDA) activity were detected by the corresponding kits. RT-PCR was performed to estimate peroxisome proliferator-activated receptor-γcoactivator-1α(PGC-1α) and manganese form of SOD (MnSOD) mRNA expression. The results demonstrated that salidroside was able to relieve EHS damage by reducing the swelling of mitochondria, ROS levels, and MDA activity, as well as increasing ΔΨm, RCR, free Ca2+concentration, SOD, PGC-1α, and MnSOD mRNA levels. In conclusion, salidroside has protective effects on mitochondrial functions against exertional heat stroke-induced organ damage in the rat.

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Rationale of Therapeutic Plasma Exchange as Rescue Immunomodulatory Treatment for MIS-C With Multiorgan Failure

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0000000000003169 ◽

2021 ◽

Vol 40 (7) ◽

pp. e259-e262

Author(s):

Franco Díaz ◽

Camila Cores ◽

Omar Atenas ◽

Nicolás Rodríguez ◽

Raúl Bustos ◽

...

Keyword(s):

Plasma Exchange ◽

Multiorgan Failure ◽

Therapeutic Plasma Exchange ◽

Immunomodulatory Treatment

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Therapeutic Plasma Exchange Application in Children Requires Individual Decision

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1714098 ◽

2020 ◽

Author(s):

Gürkan Atay ◽

Demet Demirkol

Keyword(s):

Plasma Exchange ◽

Vascular Access ◽

Pediatric Patients ◽

Demyelinating Disease ◽

Pediatric Intensive Care ◽

Therapeutic Plasma Exchange ◽

Transplantation Rejection ◽

Access Problems ◽

Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

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