Severe rhabdomyolysis in a patient with “Heat Stroke”

Clinical evaluation and laboratory data -Heat stroke (EHS) is a life-threatening illness characterized by a core body temperature elevated over 40°C and central nervous system dysfunction resulting in delirium, convulsions, cerebellar involvement or coma. -Heat stroke results from exposure to a high environmental temperature (nonexertional heat stroke) or from strenuous exercise (exertional heat stroke). -Many similarities exist between Heat Stroke and Malignant Hyperthermia. (MH). It is a pharmacogenetic disorder caused by mutations in the skeletal muscle Ca2+ release channel (or ryanodine receptor, RyR1) characterized by episodes of uncontrolled muscle contracture triggered by halogenated anesthetics such as isoflurane or halothane. -MH and EHS share many common pathological features, including rhabdomyolysis, increases in serum creatine kinase, hyperkalemia, tachycardia, metabolic acidosis, and increased muscle production of inflammatory cytokines. -Two human RyR1 mutations (R401C and R614C) are associated with MH, EHS and exercise-induced rhabdomyolysis.