In Reply.—
All of us are indebted to Dr Fine for his dedicated and persistent efforts to elucidate the pathophysiology and treatment of bacteremic and endotoxic shock. Dr Fine suggests that death in acute heat stroke could be mediated by acute disseminated intravascular coagulation (DIC) emanating from hepatic failure and absorption of endotoxin from the bowel. He further postulates that measures to interrupt this process could be life-saving.
Laboratory evidence of DIC in patients with heat stroke is extremely common and in most instances resolves spontaneously after cooling and other supportive measures. If damage occurs by this mechanism, it seems quite likely that it has already occurred by the time the patient is initially seen. It has been suggested, therefore, but not proved that heparin therapy might be useful to prevent further DIC.
Dr Fine implies that the initialing influence of DIC is acute hepatic failure. As supporting evidence, he
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