Any process that substantially diminishes arterial blood flow or arterial
oxygen content to the liver can result in hypoxic (ischaemic)
hepatitis. 90% of hypoxic
hepatitis occurs in unstable patients in intensive care units with haemodynamic failure secondary to
heart failure,
respiratory failure and
toxic shock. The rate of in-hospital mortality in hypoxic
hepatitis is very high with studies recording mortalities of 61.5%. It tends to be very uncommon in healthy, young patients with no underlying medical problems. We report here the case of a young healthy athlete who developed
heat stroke associated with
rhabdomyolysis and hypoxic
hepatitis while he was running the final stages of a marathon. The patient required
intensive care admission and inotropic support for a few hours after he was admitted with
heat stroke. He underwent a rapid recovery after he was resuscitated with fluids. N-acetyl
cysteine was also given during the acute stage of the
hepatitis. This case highlights an uncommon case of hypoxic
hepatitis in a young, healthy patient secondary to
hypotension and
heat stroke. Inotropic support might have precipitated the hypoxic
hepatitis in this young patient.