Akutní jaterní selhání vzniklé v souvislosti sesyndromem ponámahového přehřátí

Acute Liver Failure Related to the Syndrome of Exertional Heatstroke

Heatstroke syndrome is a well-described state, which usually occurs in areas with warm climates. Two forms arecommonly distinguished: the exertional and the classic heatstroke. Increased serum levels of liver enzymes are oftendetected in this condition. However, acute hepatic failure following exertional heatstroke is rare. We report a caseof a 30 years old man with exertional heatstroke, acute hepatic failure, serious coagulation impairment anda rhabdomyolysis following ten kilometres run. Acute hepatic failure completely developed the forth day ofhospitalisation. On the fifth day, the patient fulfilled London criteria for liver transplantation and was referred to thetransplantation center for the optimal management assessment. After the conservative management of acute phase,spontaneous recovery of liver functions occurred and the patient finally was not transplanted. 23 days after admissionto the hospital, the patient was discharged with residual cholestasis and was followed up on outpatient basis. Serumlevels of liver enzyme returned to the normal 3 months after the liver injury. In several cases, the liver failure followingheatstroke is reversible and conservativemanagement can be successful. Additionally, in 3 reported cases, emergencyliver transplantation for acute hepatic failure due to heatstroke with renal failure and coma showed very poor outcome.Our case demonstrates that conservative management even in patients fulfilling accepted criteria for emergency livertransplantation can be effective and should be considered in similar condition.

Key words:
acute liver failure, heatstroke, disseminated intravascular coagulopathy, rhabdomyolysis, livertransplantation.