import json

data = {
 "topic": "Heat Stroke",
 "slug": "heat-stroke",
 "category_id": 15102,
 "summary": "Heat stroke is a life-threatening failure of thermoregulation defined by a rectal temperature above 40-40.6C with CNS dysfunction, requiring immediate cooling (ideally cold water immersion) since survival and complication risk depend directly on how quickly temperature is normalized.",
 "written_by": "claude-sonnet",
 "references": [
  {"title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition", "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.", "pages": [359]},
  {"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024", "author": None, "pages": [4362]},
  {"title": "Pediatric Environmental Health", "author": "American Academy of Pediatrics Council on Environmental Health,Ruth A. Etzel,Sophie J. Balk", "pages": [486, 1060]},
  {"title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub", "author": None, "pages": []},
  {"title": "Cover", "author": "Vitalsource Download", "pages": [1780, 1781]},
  {"title": "PPE: Preparticipation Physical Evaluation", "author": "American Academy of Family Physicians, American Academy;American Academy of Pediatrics;American College of Sports Medicine;American Medical Society for Sports Medicine, American Medical;", "pages": [107, 108]},
  {"title": "MedStudy Pediatrics Core 11th Edition 2024-2025", "author": None, "pages": [315]}
 ],
 "short": [
  {"title": "In short", "content": (
   "- Heat stroke is diagnosed by a rectal temperature above 40-40.6C (104-105.1F), usually >41C (106F) in exertional cases, plus central nervous system dysfunction in a patient with an appropriate exposure history\n"
   "- Lack of sweating is NOT a required diagnostic criterion - exertional heat stroke classically presents with hot, sweaty skin, while classic (nonexertional) heat stroke presents with hot, dry (anhidrotic) skin\n"
   "- Two types: exertional (athletes, soldiers, laborers - rapid onset) and nonexertional/classic (slower onset over days, typically elderly/chronically ill, or in children most often from being left unattended in a hot vehicle)\n"
   "- Heat stroke is the 3rd leading cause of death among US high school athletes (after head injury and cardiac causes), with a US national estimate of about 9,000-9,237 heat illnesses annually in high school athletes; overall heat injury causes about 650 preventable deaths/year in the US\n"
   "- Survival after acute heat stroke has improved dramatically over the last century, from about 20% to more than 90%, but untreated mortality can be as high as 50%\n"
   "- Children are more vulnerable than adults: greater surface-area-to-mass ratio, higher metabolic heat production per kg, lower sweat rate, higher sweating threshold temperature, blunted thirst response, and longer acclimatization time (typically 8-12 near-consecutive days of 30-45 minute heat exposures)\n"
   "- Rectal temperature is the only reliable method for accurate core temperature measurement - do not rely on other sites\n"
   "- Treatment is immediate whole-body cooling; total body immersion in ice water is the most effective technique, with alternatives including ice-water towel massage, evaporative cooling (misting plus fans), or cooling blankets/ice; stop rapid cooling once core temperature reaches about 38.3-38.9C (101-102F)\n"
   "- Initial IV fluid resuscitation: isotonic fluid (normal saline or lactated Ringer) at 800 mL/m2 in the first hour per one source, or 20-40 mL/kg of normal saline per another (more for exertional heat stroke); guide further fluids by central venous pressure to avoid volume overload, and consider vasopressors if cardiac function is reduced\n"
   "- Complications include rhabdomyolysis with myoglobinuria/acute kidney injury, myocardial necrosis, hepatic degeneration, disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), seizures, and coma - risk of these complications rises the longer treatment is delayed"
  )}
 ],
 "long": [
  {"title": "Definition", "content": (
   "Heat stroke is a life-threatening failure of thermoregulation, the most severe and extreme form of heat-related illness. Diagnosis requires a rectal temperature above 40-40.6C (104-105.1F) - usually above 41C (106F) in exertional cases - together with neurologic (central nervous system) dysfunction in a patient with an appropriate heat exposure history. Importantly, lack of sweating is not a necessary diagnostic criterion: exertional heat stroke classically presents with hot, sweaty skin from intense physical exertion, whereas classic (nonexertional) heat stroke presents with hot, dry (anhidrotic) skin and develops more slowly, over days, typically in elderly or chronically ill people. In children, nonexertional heat stroke most often results from being left unattended in a vehicle, where interior temperature rises rapidly above ambient temperature."
  )},
  {"title": "Epidemiology", "content": (
   "Heat stroke is the third leading cause of death among US high school athletes, after head injury and cardiac disorders. The CDC estimates approximately 9,000-9,237 heat illnesses occur annually among US high school athletes, with football players at highest risk; emergency department visits for heat illness increased 133.5% between 1997 and 2006, and deaths from heat stroke per 100,000 American football players increased after the mid-1990s, partly attributed to rising minimum apparent (nighttime/morning) temperatures. In the US overall, heat injury causes approximately 650 preventable deaths annually. Increased severity and duration of heat waves place children at direct additional risk, with infants younger than 1 year and high school athletes appearing particularly vulnerable. Survival following acute heat stroke has improved dramatically over the past century, from an estimated 20% to more than 90%, reflecting advances in rapid recognition and cooling."
  )},
  {"title": "Pathophysiology", "content": (
   "Environmental and exertional heat illness arises from excessive heat generation and storage: high ambient temperature limits heat dissipation by radiation and convection, while high humidity limits cooling by sweat evaporation. Children are physiologically more vulnerable to heat illness than adults for several reasons: they have a greater body surface-area-to-mass ratio, produce more metabolic heat per kilogram of body weight during activity, have a lower sweat rate, sweat at a higher threshold temperature, take longer to acclimatize to hot/humid environments (typically requiring 8-12 near-consecutive days of 30-45 minute exposures), and have a blunted thirst response that can lead to inadequate fluid intake during exercise. Once heat stroke develops, cellular hypoxia, enzyme dysfunction, and disrupted cell membranes produce global end-organ derangement; cardiac output may be high, low, or normal. Risk factors for exertional heat stroke include both extrinsic factors (environment, clothing/equipment, sport type, medications, supplements) and intrinsic factors (prior history of heat stroke, inadequate acclimatization, a febrile illness or recent respiratory/GI viral illness, overexertion, dehydration, poor aerobic fitness, excess body fat, and large body size). Additional pediatric risk factors include cystic fibrosis, congenital absence of sweat glands, medications causing oligohidrosis, eating disorders, diabetes insipidus, obesity, and uncontrolled diabetes mellitus."
  )},
  {"title": "Clinical features", "content": (
   "Heat stroke symptoms resemble those of heat exhaustion, but severe CNS dysfunction is the hallmark distinguishing feature - patients may be incoherent or combative, and in severe cases can show vomiting, shivering, coma, seizures, nuchal rigidity, and abnormal posturing. Other features include tachycardia, hypertension or hypotension, headache, nausea/vomiting, tachypnea, and flushed (or, in classic heat stroke, dry/ashen) skin. Without sweating, core temperature in heat stroke can rise above 115F (46C). Heat exhaustion, by contrast, is a moderately severe heat illness with muscle cramps, fatigue, headache, nausea, vomiting, dizziness, or fainting, cool and moist skin (sweating intact), a fast weak pulse, rapid shallow breathing, and a core temperature that is normal or only slightly elevated (under 40C/104F); if untreated, heat exhaustion can progress to heat stroke. A salt-depletion variant of heat exhaustion presents with profound weakness/fatigue, frontal headache, anorexia, nausea, vomiting, diarrhea, severe muscle cramps, tachycardia, and orthostatic hypotension, with hyponatremia and hemoconcentration on labs; children with cystic fibrosis are at particular risk given impaired sweat sodium conservation."
  )},
  {"title": "Diagnostics", "content": (
   "Rectal temperature is the only reliable method for obtaining an accurate core temperature measurement and should be used to confirm the diagnosis and to guide the endpoint of cooling therapy. Monitoring should include continuous assessment of airway, breathing, circulation, core temperature, and CNS status; practical measures include placing cardiac/vital sign monitors, a rectal temperature probe, a Foley catheter, and a nasogastric tube in more severe cases. Laboratory evaluation should assess for the systemic complications of heat stroke, including electrolyte abnormalities, renal function (acute tubular necrosis/renal failure), liver function (hepatic degeneration), muscle enzymes (rhabdomyolysis), and coagulation studies (disseminated intravascular coagulation)."
  )},
  {"title": "Treatment", "content": (
   "Heat stroke is a medical emergency requiring immediate whole-body cooling - rapid cooling is the single most effective intervention to prevent organ damage and must begin immediately, ideally before or during transport rather than waiting for hospital arrival. Total body immersion in ice water is the most effective cooling technique; alternatives include massage with ice-water-soaked towels, evaporative cooling (misting cool water onto the skin with fans directed at the body), or cooling blankets/ice packs. First aid in the field should include removing the patient's clothing, applying wet towels or drenching with water, and keeping the patient in as cool an environment as possible during transport. Rapid cooling should be stopped once core temperature falls to approximately 38.3-38.9C (101-102F) to avoid overshoot/iatrogenic hypothermia. Airway, breathing, and circulation should be assessed and supported per basic/advanced life support as needed. IV or intraosseous access should be established for isotonic fluid resuscitation at room temperature; cited volumes include 800 mL/m2 in the first hour (using normal saline or lactated Ringer solution) or 20-40 mL/kg of normal saline, with exertional heat stroke patients typically requiring more fluid. After initial resuscitation, further fluid administration should be guided by central venous pressure monitoring to avoid circulatory overload, and vasopressors may be needed since cardiac function can be reduced in heat stroke victims."
  )},
  {"title": "Complications", "content": (
   "The severity of heat stroke complications is directly related to treatment delay - the longer treatment is postponed, the higher the risk of serious complications or death. Recognized complications include rhabdomyolysis (with myoglobinuria and acute kidney injury/acute tubular necrosis), myocardial necrosis, electrolyte abnormalities, hepatic degeneration, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), seizures, coma, and encephalopathy; the overall mortality rate for untreated heat stroke can reach up to 50%, though prompt, aggressive cooling has raised survival after acute heat stroke to over 90% in modern series."
  )}
 ],
 "clinical": [
  {"title": "Management at the bedside", "content": (
   "In any child or adolescent with altered mental status, incoherence, or combativeness after heat exposure or exertion, obtain a rectal temperature immediately - it is the only reliable measure of core temperature - and do not be reassured by the presence of sweating, since exertional heat stroke classically presents with hot, sweaty (not dry) skin. A rectal temperature above 40-40.6C (104-105.1F, usually >41C/106F in exertional cases) with CNS dysfunction confirms the diagnosis and mandates immediate action.\n\nBegin whole-body cooling immediately, before or during transport if at all possible - total body immersion in ice water is most effective; if unavailable, use ice-water towel massage, evaporative cooling with misting and fans, or cooling blankets/ice. Simultaneously secure airway, breathing, and circulation, and place monitors, a rectal temperature probe, and (in more severe cases) a Foley catheter and NG tube. Start isotonic IV/IO fluids (normal saline or lactated Ringer) - roughly 20-40 mL/kg or 800 mL/m2 in the first hour, more for exertional heat stroke - then guide further fluid by central venous pressure to avoid overload, adding vasopressors if cardiac function appears reduced. Stop active cooling once rectal temperature reaches about 38.3-38.9C (101-102F) to avoid overshooting into hypothermia. Send labs for electrolytes, renal and liver function, creatine kinase, and coagulation studies to catch rhabdomyolysis, acute kidney injury, hepatic injury, and DIC early, and admit for close monitoring given how rapidly these complications can evolve. Because treatment delay directly worsens outcomes, do not wait for confirmatory labs before starting cooling and fluid resuscitation."
  )}
 ]
}

with open("/tmp/heat-stroke.article.json", "w") as f:
    json.dump(data, f, indent=1)
print("written")