Hypoelectrolytemia accompanied by acute renal failure in exertional heatstroke

Thrombocytopenia as a predictor of severe acute kidney injury in patients with heat stroke

BACKGROUND

Abnormalities of blood system often occur several days before acute kidney injury (AKI) in patients with heat stroke (HS). We aimed to investigate the prevalence and prognostic value of the early hematological markers in patients with AKI induced by HS.

METHODS

In a retrospective cohort study, we analyzed the case records of 176 patients with HS and evaluated the hematological markers for early prediction and risk classification in the patients with AKI.

RESULTS

Of 176, 103 (58%) HS cases developed AKI, and men comprised more than half (75%) of the sample population. The nadir platelet count significantly correlated with the levels of peak serum creatinine (r = -0.608, p < 0.01) and blood urea nitrogen (r = -0.546, p < 0.01), and the length of hospital stay (r = -0.393, p < 0.01). The areas under the receiver operating characteristic curves (AU-ROC) indicated the prognostic accuracy of hematological markers, AU-ROC was significantly higher with the nadir platelet count than that with the admission platelet count (AU-ROC of the nadir platelet: 0.73; 95% CI: 0.67-0.82; vs. AU-ROC of the admission platelet: 0.67; 95% CI: 0.59-0.75; p < 0.01). Multiple logistic regression results indicated that the nadir platelet count (adjusted ORs: 37.92; 95% CI: 2.18-87.21; p < 0.01) was independent predictor of AKI in HS.

CONCLUSION

The high mortality observed in HS complicated with AKI, and among the various hematological parameters assessed, thrombocytopenia is associated with AKI induced by HS independently.

Rhabdomyolysis and hyponatremia: a cluster of five cases at the 161-km 2009 Western States Endurance Run

OBJECTIVE

Five of 400 starters of the 2009 Western States Endurance Run (WSER) were hospitalized with hyponatremia and rhabdomyolysis. This article explores the risk factors associated with development of hyponatremia and rhabdomyolysis.

METHODS

Data on the 5 cases were collected retrospectively from the runners and medical records, and all race participants were invited to complete a post-race survey. Characteristics of the cases were compared with the other race participants.

RESULTS

The 5 runners developing hyponatremia with rhabdomyolysis were men with a mean (±SD) age of 39 ± 7 years. Presenting complaints included neurological symptoms among 3 and nausea among 3. Compared with those runners not developing hyponatremia with rhabdomyolysis, the cases tended to be younger, faster, more likely to have sustained an injury which interfered with training prior to the race, and were more likely to use nonsteroidal anti-inflammatory drugs (NSAIDs) during the race. The 3 of 5 cases progressing to acute renal failure were characterized by higher initial blood urea nitrogen (BUN; 43-69 vs 18-23 mg/dL) and creatinine (2.8-4.9 vs 1.1-1.2 mg/dL) levels but were not distinguished by creatinine phosphokinase (CPK) concentrations.

CONCLUSIONS

Over 1% of participants in the 2009 WSER were hospitalized with hyponatremia in combination with rhabdomyolysis. These individuals tended to be younger, faster, more likely to have had an injury that interfered with training, and more likely to have used NSAIDs during the race. Higher initial BUN and creatinine levels, but not CPK concentrations, distinguished those 3 who progressed to acute renal failure.

Two centuries of meningococcal infection: from Vieusseux to the cellular and molecular basis of disease

Scientific knowledge of meningococcal infection has increased greatly since the epidemic nature of the illness was first described by Vieusseux at the dawn of the nineteenth century. In fact, revolutionary advances have been made in public-health measures, antimicrobial therapy, diagnostic procedures, anti-inflammatory drugs and supportive care facilities. Based on the knowledge accumulated to date, it is generally accepted that the pathogenesis of meningococcal infection involves multiple links that interconnect in a complex web of phenomena from Neisseria meningitidis attachment to meningococcal sepsis or meningitis. In fact, a myriad of strongly interacting inflammatory molecules and cells have been implicated in neisserial infection, illustrating the complexity of meningococcal pathogenesis. In addition, many of these signallers are critically involved in outcomes in the human host. Deciphering the pathogenesis of meningococcal infection could expand our knowledge and provide important clues to the host-pathogen interaction, as well as leading to the development of new therapeutic tools. Herein, we review the history of the discovery and characterization of meningococcal disease, epidemiological features of the disease with an emphasis on recent developments in Brazil, the cellular and molecular basis of disease, and discuss diagnosis and therapy.