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Previous Volume 346:1978-1988 June 20, 2002 Number 25 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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Heat stroke is a life-threatening illness characterized by an elevated core body temperature that rises above 40°C and central nervous system dysfunction that results in delirium, convulsions, or coma.¹ Despite adequate lowering of the body temperature and aggressive treatment, heat stroke is often fatal, and those who do survive may sustain permanent neurologic damage.^1,2 Data from the Centers for Disease Control and Prevention show that from 1979 to 1997, 7000 deaths in the United States were attributable to excessive heat.³ The incidence of such deaths may increase with global warming and the predicted worldwide increase in the frequency and intensity . . . [Full Text of this Article]

Definition and Incidence

Pathogenesis

Thermoregulation

Acclimatization

Acute-Phase Response

Heat-Shock Response

Progression from Heat Stress to Heat Stroke

            Thermoregulatory Failure

            Exaggeration of the Acute-Phase Response

            Alteration of Heat-Shock Response

Pathophysiology

Heat

Cytokines

Coagulation Disorders and Endothelial-Cell Injury

Clinical and Metabolic Manifestations

Treatment

Cooling

Prevention

Emerging Concepts

Conclusions

Source Information

From the Medical and Surgical Intensive Care Unit and Comparative Medicine Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia (A.B.); and the Department of Internal Medicine, Presbyterian Hospital of Dallas, Dallas (J.P.K.).

Address reprint requests to Dr. Knochel at the Department of Internal Medicine, Presbyterian Hospital of Dallas, 8198 Walnut Hill Ln., Dallas, TX 75231, or at jamesknochel@texashealth.org.

References

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• Protasi, F., Paolini, C., Dainese, M. (2009). Calsequestrin-1: a new candidate gene for malignant hyperthermia and exertional/environmental heat stroke. J. Physiol. 587: 3095-3100 [Abstract] [Full Text]  
• Dainese, M., Quarta, M., Lyfenko, A. D., Paolini, C., Canato, M., Reggiani, C., Dirksen, R. T., Protasi, F. (2009). Anesthetic- and heat-induced sudden death in calsequestrin-1-knockout mice. FASEB J. 23: 1710-1720 [Abstract] [Full Text]  
• Di Lorenzo, C, Ambrosini, A, Coppola, G, Pierelli, F (2009). Heat stress disorders and headache: a case of new daily persistent headache secondary to heat stroke. BMJ Case Reports 2009: bcr0820080700-bcr0820080700 [Abstract] [Full Text]  
• Zimmerman, J. L. (2009). Hypothermia, Hyperthermia, and Rhabdomyolysis. ACCP Crit Care Med Brd Rev 20: 321-332 [Full Text]  
• Trujillo, M. H., Bellorin-Font, E., Fragachan, C. F., Perret-Gentil, R. (2009). Multiple Organ Failure Following Near-fatal Exertional Heat Stroke. J Intensive Care Med 24: 72-78 [Abstract]  
• DeFranco, M. J., Baker, C. L. III, DaSilva, J. J., Piasecki, D. P., Bach, B. R. Jr (2008). Environmental Issues for Team Physicians. Am J Sports Med 36: 2226-2237 [Abstract] [Full Text]  
• Basu, R., Ostro, B. D. (2008). A Multicounty Analysis Identifying the Populations Vulnerable to Mortality Associated with High Ambient Temperature in California. Am J Epidemiol 168: 632-637 [Abstract] [Full Text]  
• Selkirk, G. A., McLellan, T. M., Wright, H. E., Rhind, S. G. (2008). Mild endotoxemia, NF-{kappa}B translocation, and cytokine increase during exertional heat stress in trained and untrained individuals. Am. J. Physiol. Regul. Integr. Comp. Physiol. 295: R611-R623 [Abstract] [Full Text]  
• Bouchama, A., Kunzelmann, C., Dehbi, M., Kwaasi, A., Eldali, A., Zobairi, F., Freyssinet, J.-M., de Prost, D. (2008). Recombinant Activated Protein C Attenuates Endothelial Injury and Inhibits Procoagulant Microparticles Release in Baboon Heatstroke. Arterioscler. Thromb. Vasc. Bio. 28: 1318-1325 [Abstract] [Full Text]  
• Roberts, G. T., Ghebeh, H., Chishti, M. A., Al-Mohanna, F., El-Sayed, R., Al-Mohanna, F., Bouchama, A. (2008). Microvascular Injury, Thrombosis, Inflammation, and Apoptosis in the Pathogenesis of Heatstroke: A Study in Baboon Model. Arterioscler. Thromb. Vasc. Bio. 28: 1130-1136 [Abstract] [Full Text]  
• Di Lorenzo, C, Ambrosini, A, Coppola, G, Pierelli, F (2008). Heat stress disorders and headache: a case of new daily persistent headache secondary to heat stroke. J. Neurol. Neurosurg. Psychiatry 79: 610-611 [Full Text]  
• Brandom, B. W., Broadman, L. M., Ozolek, J. A., Phadke, A. S., Davis, P. J. (2008). Could This Be Malignant Hyperthermia?. Anesth. Analg. 106: 1328-1329 [Full Text]  
• Frumkin, H., Hess, J., Luber, G., Malilay, J., McGeehin, M. (2008). Climate Change: The Public Health Response. AJPH 98: 435-445 [Abstract] [Full Text]  
• Harris, B. A., Andrews, P. J. D., Marshall, I., Robinson, T. M., Murray, G. D. (2008). Forced convective head cooling device reduces human cross-sectional brain temperature measured by magnetic resonance: a non-randomized healthy volunteer pilot study. Br J Anaesth 100: 365-372 [Abstract] [Full Text]  
• Page, L. A., Hajat, S., Kovats, R. S. (2007). Authors' reply. Br. J. Psychiatry 191: 560-561 [Full Text]  
• Bouchama, A., Dehbi, M., Mohamed, G., Matthies, F., Shoukri, M., Menne, B. (2007). Prognostic Factors in Heat Wave Related Deaths: A Meta-analysis. Arch Intern Med 167: 2170-2176 [Abstract] [Full Text]  
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• Phadke, A., Broadman, L. M., Brandom, B. W., Ozolek, J., Davis, P. J. (2007). Postoperative Hyperthermia, Rhabdomyolysis, Critical Temperature, and Death in a Former Premature Infant After His Ninth General Anesthetic. Anesth. Analg. 105: 977-980 [Abstract] [Full Text]  
• O'Malley, P. G. (2007). Heat Waves and Heat-Related Illness: Preparing for the Increasing Influence of Climate on Health in Temperate Areas. JAMA 298: 917-919 [Full Text]  
• Jardine, D. S. (2007). Heat Illness and Heat Stroke. Pediatr. Rev. 28: 249-258 [Full Text]  
• Belmin, J., Auffray, J.-C., Berbezier, C., Boirin, P., Mercier, S., de Reviers, B., Golmard, J.-L. (2007). Level of dependency: a simple marker associated with mortality during the 2003 heatwave among French dependent elderly people living in the community or in institutions. Age Ageing 36: 298-303 [Abstract] [Full Text]  
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• Lim, C. L., Wilson, G., Brown, L., Coombes, J. S., Mackinnon, L. T. (2007). Pre-existing inflammatory state compromises heat tolerance in rats exposed to heat stress. Am. J. Physiol. Regul. Integr. Comp. Physiol. 292: R186-R194 [Abstract] [Full Text]  
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• Kwok, J. S., Chan, T. Y. (2005). Recurrent Heat-Related Illnesses During Antipsychotic Treatment. The Annals of Pharmacotherapy 39: 1940-1942 [Abstract] [Full Text]  
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• Varghese, G M, John, G, Thomas, K, Abraham, O C, Mathai, D (2005). Predictors of multi-organ dysfunction in heatstroke. Emerg. Med. J. 22: 185-187 [Abstract] [Full Text]  
• Bouchama, A., Roberts, G., Al Mohanna, F., El-Sayed, R., Lach, B., Chollet-Martin, S., Ollivier, V., Al Baradei, R., Loualich, A., Nakeeb, S., Eldali, A., de Prost, D. (2005). Inflammatory, hemostatic, and clinical changes in a baboon experimental model for heatstroke. J. Appl. Physiol. 98: 697-705 [Abstract] [Full Text]  
• Stephan, F., Ghiglione, S., Decailliot, F., Yakhou, L., Duvaldestin, P., Legrand, P. (2005). Effect of excessive environmental heat on core temperature in critically ill patients. An observational study during the 2003 European heat wave. Br J Anaesth 94: 39-45 [Abstract] [Full Text]  
• Leon, L. R., DuBose, D. A., Mason, C. W. (2005). Heat stress induces a biphasic thermoregulatory response in mice. Am. J. Physiol. Regul. Integr. Comp. Physiol. 288: R197-R204 [Abstract] [Full Text]  
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• Maron, B. J. (2003). Sudden Death in Young Athletes. NEJM 349: 1064-1075 [Full Text]  
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• Basu, R., Samet, J. M. (2002). Relation between Elevated Ambient Temperature and Mortality: A Review of the Epidemiologic Evidence. Epidemiol Rev 24: 190-202 [Full Text]