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pathophysiology of heat-related illness and death :: www.forensicmed.co.uk
Heat-related illness can occur when high ambient temperature exceeds the ability of the body to dissipate heat.
Multi-organ failure is the ultimate mode of death, and
heat-related mortality is high – ranging between 33 and 80%.
The post-mortem diagnosis of heat-related deaths presents certain difficulties.
Firstly, pre-terminal or terminal
body temperatures are often not available. Additionally,
naked-eye and microscopic findings are non-specific or inconclusive and depend on the duration of survival after exposure.
The
diagnosis of hyperthermia is based on scene investigation, the
circumstances of death, and the
reasonable exclusion of other causes of death.
A heat-related cause of death may be assumed if the investigations provide compelling evidence of continuous exposure to a hot environment, and fail to identify an independent cause of death (Nixdorf-Miller et al 2006, and Palmiere and Mangin 2013).
The
non-specific post-mortem findings in cases of fatal heatstroke include: pulmonary and cerebral oedema, necrosis of the liver, neuronal degeneration of the brain, rhabdomyolysis (breakdown of muscle), tubular casts in the kidneys and signs of disseminated intravascular coagulation e.g. fibrin thrombi in small blood vessels (Palmiere and Mangin 2013).
The
post-mortem biochemistry findings are related to
dehydration, electrolyte disturbance and skeletal muscle damage. They include increased serum creatinine, mild-to-moderate elevation of urea, and myoglobinuria, however, the
diagnosis of heat-related fatalities cannot be based on post-mortem biochemical analyses alone (Palmiere and Mangin 2013).
Why some cases progress to heatstroke and others do not is unclear but it appears that
genetic differences (polymorphisms) may determine susceptibility i.e. it is likely there is an individual variability to tolerating temperature changes (Epstein and Roberts 2011, Sucholeiki 2005, and Yeo 2004).