Fulminant hepatic failure from heat stroke requiring liver transplantation

A 16-year-old man developed heat stroke during football practice when the t emperature was 33.8 degrees C (heat index, 44.4 degrees C). Resuscitation w ith ice water lavage, external cooling, and intravenous fluids was initiall y successful, but the patient again became obtunded. Liver chemistry tests and the prothrombin time and serum ammonia increased markedly, and rhabdomy olysis and renal failure became evident, necessitating hemodialysis. He und erwent liver transplantation for fulminant hepatic failure approximately 72 hours after admission. Rhabdomyolysis with renal failure and severe electr olyte disturbances continued despite aggressive hemodialysis and the patien t had a cardiopulmonary arrest and died 10 days after transplantation. This case shows that liver transplantation cannot always overcome the generaliz ed toxic effects of heat stroke. More aggressive hemodialysis or combined l iver/kidney transplantation might result in a positive outcome in selected cases.