Srpski arhiv za celokupno lekarstvo 2014 Volume 142, Issue 5-6, Pages: 360-364
https://doi.org/10.2298/SARH1406360S
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Death caused by heat stroke: Case report
Savić Slobodan (School of Medicine, Institute of Forensic Medicine, Belgrade)
Pavlekić Snežana (School of Medicine, Institute of Forensic Medicine, Belgrade)
Alempijević Đorđe (School of Medicine, Institute of Forensic Medicine, Belgrade)
Ječmenica Dragan (School of Medicine, Institute of Forensic Medicine, Belgrade)
Introduction. Heat stroke is the most dangerous among numerous disorders
caused by elevated environmental temperature. It is characterized by an
increased body temperature of over 40°C, the dysfunction of the central
nervous system and the development of multiple organ failure. The aim of this
paper was to highlight problems in the clinical and post-mortal diagnosis of
fatal heat stroke. Case Outline. A 20-year-old male was found unconscious on
the street; on admission at the Emergency Center, Clinical Center of Serbia,
Belgrade, he was in a coma. The body temperature of 40°C was maintained
despite the applied therapy, meningeal signs were negative, tachycardia with
gallop rhythm, hypotension, bleeding from the nose and mouth, and presence of
skin bruises. Laboratory findings: highly elevated LDH and creatine kinase,
elevated serum creatinine, AST, and signs of DIC. Lethal outcome occurred 6
hours after admission, and the case remained clinically unsolved. Autopsy
showed signs of hemorrhagic diathesis, brain and pulmonary edema, and
microscopic examination revealed general congestion, internal bleeding in
various organs, cerebral edema, massive blood aspiration and pulmonary edema.
Toxicological and bacteriological examinations were negative. Based on these
findings and subsequently obtained data on the conditions at the workplace
where the young man had a part-time job, it was concluded that the violent
death was caused by heat stroke. Conclusion. Since heat stroke is associated
with a high mortality rate and high incidence of serious and permanent organ
damage in survivors, it is important to make the diagnosis of heat stroke as
quickly as possible and apply appropriate treatment. Misdiagnosis of heat
stroke, and consequently inadequate treatment, with a potential fatal outcome
for the patient, can be the reason for blaming doctors for the legal offense
of medical malpractice in failing to administer first aid.
Keywords: heat stroke, sudden unexpected death, forensic medicine diagnosis