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The 34\u2010year\u2010old male US worker developed life\u2010threatening heat\u2010related illness in August 2018, on his first day back at work after a 7\u2010day absence. The worker initially presented with bilateral hand then all\u2010extremity cramping followed some hours later by a generalized seizure and acute mental status changes, including combativeness. Emergency room evaluation identified a serum sodium level of 114\u2009mmol\/L. Acute liver and kidney injury ensued along with profound rhabdomyolysis, with peak total creatinine phosphokinase level reaching over 125\u2009000 units\/L at 3 days post incident. Initial ventilatory support, careful fluid resuscitation, and electrolyte management were provided. Metabolic encephalopathy resolved. Complications included sepsis. After 5 days in the intensive care unit and eight additional days of inpatient management, observation, and the initiation of rehabilitation, the worker was discharged. Residual effects include polyneuropathy of upper and lower extremities and the postdischarge magnetic resonance imaging finding of a cerebellar lesion. Prevailing considerations in the differential diagnosis included exertional heat stroke and\/or exertion\u2010associated hyponatremia with encephalopathy.<\/jats:p>","DOI":"10.1002\/ajim.23061","type":"journal-article","created":{"date-parts":[[2019,10,24]],"date-time":"2019-10-24T17:31:21Z","timestamp":1571938281000},"page":"1068-1075","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Life\u2010threatening heat\u2010related illness with severe hyponatremia in an aluminum smelter worker"],"prefix":"10.1002","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8408-603X","authenticated-orcid":false,"given":"James C.","family":"Wesdock","sequence":"first","affiliation":[{"name":"Alcoa Corporation  Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7999-0582","authenticated-orcid":false,"given":"A. Michael","family":"Donoghue","sequence":"additional","affiliation":[{"name":"Alcoa Alumina  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,10,24]]},"reference":[{"issue":"11","key":"e_1_2_11_2_1","first-page":"1325","article-title":"Heat\u2010related illness","volume":"83","author":"Becker JA","year":"2011","journal-title":"Am Fam Physician"},{"issue":"8","key":"e_1_2_11_3_1","first-page":"482","article-title":"Heat\u2010related illnesses","volume":"99","author":"Gauer R","year":"2019","journal-title":"Am Fam Physician"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra011089"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-50.9.07"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1249\/00005768-199002000-00003"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/JOM.0000000000001365"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/JOM.0000000000000062"},{"key":"e_1_2_11_9_1","unstructured":"World Aluminum.Hall\u2010H\u00e9roult smelting process.www.world\u2010aluminium.org. 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