Poster 220 Rehabilitation of a 30-Year-Old Man After Exertional Heatstroke and Multiorgan Failure: Rhabdomyolysis, Renal and Hepatic Failure, and Subsequent Liver Transplantation. A Case Report

Patients or Programs: A 30-year-old man. Program Description: A previously healthy and physically active 30-year-old male police officer with no known medical history, or drug and/or alcohol use or abuse, collapsed and was found unresponsive while running an endurance race on a hot day. It was determined that he had developed exertional heatstroke (EHS), which induced a multiorgan injury that included rhabdomyolysis, acute renal failure, and fulminant liver failure. He subsequently underwent successful liver transplantation. Extensive workup failed to reveal alternative explanation for the multiorgan failure except for the heatstroke. Approximately 2 months after his collapse, he was transferred to our acute rehabilitation unit. Examination on admission showed generalized muscle atrophy and weakness, with proximal muscles barely antigravity in strength. He needed maximum assistance to get out of bed, stand up, and walk. Setting: Acute inpatient rehabilitation unit. Results: He progressed rapidly during his 15-day rehabilitation stay and achieved significant gains in proximal muscle strength to 4/5. At discharge to home, he was at a level of modified independence with activities of daily living and able to ambulate 150 ft with supervision by using a single point cane. His Functional Independence Measures efficiency (Functional Independence Measures change per length of stay) was 2.8. Discussion: In a literature search, there were only 4 other reported patients with EHS that were treated with orthotopic liver transplantation, 3 of whom did not survive. EHS is a life-threatening condition that is characterized by core hyperthermia (body temperature higher than 41°C) and central nervous system dysfunction. Exertional heatstroke develops in healthy, active people during intense physical exertion when heat gain overwhelms the body's mechanisms of heat loss. Risk factors for EHS include dehydration, fatigue, and lack of acclimatization. Conclusions: Exertional heatstroke can lead to multiorgan failure and death if not promptly recognized and treated emergently. For those who survive heatstroke, timely rehabilitation is the key to restoring function.