Raj VMS, Alladin A, Pfeiffer B, Katsoufis C, Defreitas M, Edwards-Richards A, Chandar J, Seeherunvong W, McLaughlin G, Zilleruelo G, Abitbol CL. Therapeutic plasma exchange in the treatment of exertional heat stroke and multiorgan failure.
Pediatr Nephrol 2013;
28:971-4. [PMID:
23338054 DOI:
10.1007/s00467-013-2409-8]
[Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 12/24/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND
Exertional heat stroke (EHS) results in a constellation of systemic inflammatory responses resulting in multiorgan failure and an extremely high mortality.
CASE DIAGNOSIS AND TREATMENTS
We present the case of an 11-year-old obese male who suffered EHS with rhabdomyolysis and concurrent renal, pulmonary, and hepatic failure. Conventional therapies including continuous veno-venous hemodiafiltration (CVVHDF) were ineffective in preventing ongoing deterioration in clinical status. Liver biopsy was reported as "extensive hepatocyte ballooning" and liver-kidney transplantation was tentatively planned.
CONCLUSIONS
The addition of therapeutic plasma exchange using the Prismaflex® system (Gambro, Lakewood, CO, USA) resulted in a reversal of the inflammatory process and recovery from multiorgan failure. Liver biopsy was not a reliable indicator of irreversible hepatic injury.
Collapse