ENDOTOXEMIA AND RELEASE OF TUMOR-NECROSIS-FACTOR AND INTERLEUKIN-1-ALPHA IN ACUTE HEATSTROKE

To determine whether endotoxemia and release of tumor necrosis factor (TNF-alpha) and/or interleukin 1-alpha (IL-1-alpha) are involved in the pathogenesis of heatstroke, 17 adult patients with a mean rectal temperature of 42.1 +/- 0.2-degrees-C were studied. Blood samples were taken on admission and after cooling was completed. TNF-alpha and IL-1-alpha levels were measured by enzyme-linked immunosorbent assay, and lipopolysaccharide (LPS) content was measured by the chromogenic substrate modification of the Limulus amebocyte lysate. TNF-alpha, IL-1-alpha, and LPS were elevated in all patients [199 +/- 25 (SE) pg/ml, 480.5 +/- 68.3 pg/ml, and 8.60 +/- 1.19 ng/ml, respectively, compared with normal control values of 31.4 +/- 8.4 pg/ml, 53.7 +/- 5.32 pg/ml, and < 9 pg/ml]. There was no significant correlation between temperature and the circulating concentration of TNF-alpha, IL-1-alpha, and LPS. Post-cooling TNF-alpha, IL-1-alpha, and LPS concentrations were significantly decreased but still above normal control values. The findings suggest that these mediators may have a role in the pathogenesis of heatstroke that could change the strategy of management.