Late Care in Marathon Runs Leading to Exertional Heat Stroke with Multiple Organ Failure

BACKGROUND: Exertional heat stroke (EHS) is still a main cause of death in sport. Many of EHS complications could have been prevented if EHS had been recognized and treated early and properly. CASE PRESENTATION: We report an unusual case of multiple organ failure caused by EHS due to intensive sportive activities in a hot environment with lack of primary care. A 35-year-old healthy sportive man was admitted in our hospital because of muscle aches and weakness as well as dark urine three days after a six hour marathon run (Agadir Semi-Marathon) in a very sunny day. Patient developed rhabdomyolysis, acute renal failure (ARF) requiring hemodialysis because of hyperkaliémia, azotémia and severe metabolic acidosis, disseminated intravascular coagulation and acute liver failure. Unfortunately, after eight days of intensive care, the patient died from septic shock and multiple organ failure. CONCLUSION: This case reminds us that, despite the advancements of knowledge in the area of EHS prevention, recognition, and treatment, knowledge has not been translated into practice.