Introduction:

Today, Dr. Rahul Damania, Dr. Pradip Kamat, and their guest, Dr. Jordan Dent, discuss a critical case involving a 15-year-old male who collapsed during football practice due to exertional heat stroke. The discussion emphasizes the clinical presentation, risk factors, pathophysiology, and evidence-based management of heat stroke and other heat-related illnesses in pediatric patients. The episode also delves into the role of rapid cooling interventions and long-term care to minimize mortality and morbidity.

Case Summary: A 15-year-old male with ADHD collapsed during football practice on a hot, humid day. He presented with:

Normotension (BP: 101/67 mmHg)
Tachycardia (HR: 157 bpm)
Tachypnea (RR: 40 breaths/min)
Febrile (Rectal temp: 41.8°C/107.2°F)
Dry, hot skin, GCS of 9
Lab abnormalities: hyponatremia, hypokalemia, hypoglycemia, elevated creatinine, liver enzymes, lactate, CK, and troponin

After suffering cardiac arrest and undergoing resuscitation, the patient developed multiorgan dysfunction, including seizures, encephalopathy, and cerebral edema. Despite severe initial complications, the patient demonstrated neurological improvement with left-side hemiparesis before discharge.

Key Discussion Points:

Etiology and Pathophysiology of Heat Stroke:

Heat stroke occurs when the body’s thermoregulatory mechanisms fail, leading to dangerous elevations in core body temperature. Exertional heat stroke is common during strenuous physical activity in hot, humid environments.
Key physiological breakdowns include inadequate sweating, vasodilation dysfunction, and subsequent cellular damage due to hyperthermia.

Risk Factors for Exertional Heat Stroke:

Environmental factors: High temperature, humidity, lack of hydration, and breaks.
Athlete-related factors: Hypohidrosis, dehydration, medical conditions, and medications (e.g., Adderall).
Heat illness is the third leading cause of death in high school athletics, with American football players particularly at risk.

Spectrum of Heat-Related Illness:

Heat Cramps: Involuntary muscle contractions due to dehydration and electrolyte imbalance.
Heat Syncope: Transient loss of consciousness due to heat exposure.
Heat Exhaustion: Milder heat illness with core temperature < 104°F, potentially progressing to heat stroke if untreated.

It’s Getting Hot in Here | Heat Stroke in the PICU

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