Name
HEAT STROKE
DESCRIPTION
DETAIL
DIFFERENTIAL DIAGNOSIS . Other causes of elevated temperature, dehydration or circulatory collapse . Febrile illnesses, sepsis . Drug-induced fl uid loss . Cardiac arrhythmia or infarction . Acute cocaine intoxication . Malignant hyperthermia (an autosomally inherited disorder of skeletal and cardiac muscle in which patients have abnormal muscle metabolism on exposure to halothane or skeletal muscle reactants) -------------------------------------------------------------------------- CAUSES Failure of heat-dissipating mechanisms or an overwhelming heat stress leading to a rise in core temperature, dehydration and salt depletionLABORATORY TESTS : β’ Used primarily to detect end-organ damage β’ Electrolytes, urinalysis β’ Creatinine, blood urea nitrogen β’ Liver enzymes β’ Complete blood count β’ Increased urine specific gravity β’ Results of above studies yield hypernatremia, hyperchloremia, hemoconcentration
TYPENOTES
RISK FACTORS: Poor acclimatization to heat or poor physical conditioning, Salt or water depletion, Obesity, Acute febrile or gastrointestinal illnesses, Chronic illnesses - uncontrolled diabetes or hypertension, cardiac disease, AlcoholGENERAL MEASURES o Rapid cooling - remove clothing, wet patient down, ice packs o Fluid and electrolyte replacement with hypotonic oral fluids or IV 0.5-1.0 liter normal saline o Consider central venous pressure monitoring ACTIVITY Rest with legs elevated DIET o Cool or cold clear liquids only (non-carbonated) o Avoid caffeine o Unrestricted sodium PATIENT EDUCATION o Stress the importance of proper conditioning and acclimatization o Instruct patients to recognize heat stress signs and symptoms o Maintain as much skin exposure as possible in hot, humid conditions, while using proper sun block protection o Avoid dehydration with proper fluids during activity or exercise - 8 oz fluid intake for every 15 minutes of moderate exercise o Never leave children unattended in cars during hot weather o Try to gain access to air conditioned environment during hot weather DRUG(S) OF CHOICE No medications are required in the initial management. Use isotonic saline solution to rehydrate. ALTERNATIVE DRUGS o Consider immunomodulators such as corticosteroids o In disseminated intravascular coagulation, consider appropriate replacement therapy PATIENT MONITORING o Rectal temperature monitoring - cooling may be discontinued when the core temperature drops to 102Β°F (38.9Β°C) and stabilizes o Heat stroke patients may require airway management, hemodynamic monitoring and careful fluid and electrolyte administration and monitoring o Consider central venous pressure monitoring PREVENTION/AVOIDANCE Most important factor in preventing heat stress is adequate fluid replacement. Allow acclimatization to hot weather through proper conditioning and activity modifi cation. Dress appropriately with loose-fitting, open weave, light-colored clothing. POSSIBLE COMPLICATIONS o May involve failure of any major organ system o Cardiac arrhythmias or infarction o Pulmonary edema, adult respiratory distress syndrome o Coma, seizures o Acute renal failure o Rhabdomyolysis o Disseminated intravascular coagulation o Hepatocellular necrosis EXPECTED COURSE/PROGNOSIS o Good when mental function is not altered and when serum enzymes are not elevated. Recovery is within 24-48 hours in most cases. o The mortality rate for heat stroke (10-80%) is directly related to the duration and intensity of hyperthermia as well as to the speed and effectiveness of diagnosis and treatment
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
BLOOD UREA, SERUM CREATININE, SERUM SODIUM, SERUM POTASSIUM, SERUM CHLORIDE, URINE ROUTINE, COMPLETE BLOOD COUNT, LIVER FUNCTION TEST
MISCELLANEOUS - AROMA
[HEAT STROKE]