Introduction The term heat-related illness encompasses a continuum of disorders from minor illnesses, such as heat cramps, to the life-threatening heatstroke. Certain populations are at greater risk for developing these illnesses: the elderly, those with chronic medical conditions, those with mental illnesses, and children. Children are more likely to suffer from heat-related illnesses because of an increased surface area to body mass ratio because of a decreased amount of sweating in response to heat and because they do not instinctively replace fluid losses or limit exercise in extreme heat. Neonates and infants are at even greater risk because they have poor thermoregulatory control.
Case Report A 17-day-old black male, born at 36 weeks, presented to the emergency department (ED) by ambulance with fever, tachycardia, hypotension, poor perfusion, altered mental status, and impending respiratory failure. The mother had noted that the patient "looked sick " after a 31/2-hour car ride without air conditioning on a hot July day in Alabama. His temperature at home was 104.0 degrees; he had vomited bright yellow emesis, was breathing fast, and would not keep his eyes open. In the ED he was intubated, was resuscitated with 60 cc/kg of normal saline (which resulted in improved perfusion, heart rate improving from 250 to 182, and the first obtainable blood pressure of 55/12), and was started on empiric antibiotics after blood, urine, and spinal fluid cultures were obtained. His physical exam was significant for a markedly distended abdomen with stacked loops of bowel as well as a grossly bloody stool. He was admitted to the intensive care unit where resuscitation continued with normal saline, packed red blood cells, fresh frozen plasma, and dopamine. His initial head CT was normal and his echocardiogram showed normal heart structure and function. His upper GI was negative for volvulus, and all abdominal X-rays showed no signs of necrotizing enterocolitis. All bacterial cultures were negative. CSF enteroviral PCR and HSV PCR were both negative. His coagulopathy slowly resolved. He remained in the hospital for 12 days and was discharged home with an abnormal neurologic exam (increased tone throughout), but all other organ systems were back to normal.
Discussion This case highlights the fact that the differential diagnosis for neonates presenting with shock is vast. While we had the history of hyperthermia after an extended period of time in a hot car, we had to consider all other causes of shock in this age group.
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