Atypical Heat Stroke, with Hypernatremia, Acute Renal Failure, and Fulminating Potassium Intoxication

Abstract

The criteria for the diagnosis of heat stroke are well known, but atypical clinical findings, such as abnormal behavior patterns without severe hyperpyrexia following exposure to heat, may go unrecognized.¹ Detailed chemical studies are lacking in all reported cases of heat injury. A small but definite incidence of acute renal failure occurring in the course of severe heat injury has been reported.¹,¹⁶,¹⁸ However, relatively little clinical and chemical detail has been included. Three fatal cases of heat injury with oliguria occurring in military personnel stationed near San Antonio, Texas, are presented to (1) describe some clinical and chemical findings that may precede this atypical clinical form of heat stroke, (2) suggest means of preventing the associated acute renal failure with oliguria, and (3) account for the deaths of these patients on the basis of shock, persistent hyperthermia, and remarkably rapid rise in plasma potassium concentration with