The metabolic and respiratory alterations of heat stroke

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Abstract
The metabolic and respiratory changes of 21 patients with heat stroke were studied. Admission arterial blood gas levels were measured, and serum bicarbonate, lactate, Ca, P and anion gap determinations were performed. Seven patients had a metabolic acidosis (pH 7.20 .+-. 0.04 PCO2 [partial pressure of CO2] 32 .+-. 2 mm Hg and bicarbonate 12 .+-. 1 meq/l, 7 a combined metabolic acidosis and respiratory alkalosis (pH 7.39 .+-. 0.01, PCO2 25 .+-. 1 mm Hg and bicarbonate 15 .+-. 1 meq/l), 4 a respiratory alkalosis (pH 7.45 .+-. 0.01, PCO2 30 .+-. 1 mm Hg and bicarbonate 20 .+-. 1 meq/l), 1 a metabolic and respiratory acidosis (pH 7.13, PCO2 52 mm Hg and bicarbonate 17 meq/l), and 1 a respiratory acidosis (pH 7.30, PCO2 56 mm Hg and bicarbonate 27 meq/l). The 15 patients with a metabolic acidosis had a pH of 7.28 .+-. 0.03, PCO2 of 30 .+-. 2 mm Hg bicarbonate level of 14 .+-. 1 meq/l, lactate concentration of 6.5 .+-. 1.0 meq/l and an anion gap of 26 .+-. 4 meq/l. Nine patients were hypocalcemic (7.8 .+-. 0.3 mg/dl), and 5 patients were hypophosphatemic (2.0 .+-. 0.2 mg/dl). The predominant metabolic change in heat stroke is a metabolic acidosis secondary to increased lactate content and/or a respiratory alkalosis. Hypocalcemia is common and hypophosphatemia is not infrequent.

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