Heat Syndrome

Humans normally adjust to excessive temperatures through complex cardiovascular and neurologic changes, which are coordinated by the hypothalamus. Heat loss offsets heat production to regulate the body temperature. It does this by evaporation (of sweat) or vasodilation, which cools the body's surface by radiation, conduction, and convection.

Sometimes both environmental and internal factors can increase heat production or decrease heat loss beyond the body's ability to compensate. When this happens, heat syndrome results. There are three categories of heat syndrome: heat cramps, heat exhaustion, and heatstroke.

Causes

Heat syndrome may result from conditions that increase heat production, such as excessive exercise, infection, and drugs (for example. amphetamines). It can also stem from factors that impair heat dissipation including high temperatures or humidity, lack of acclimatization, excess clothing, cardiovascular disease, obesity, dehydration, sweat gland dysfunction, and drugs such as phenothiazines and anticholinergics.

Heatstroke is commonly seen in elderly people on excessively hot summer days, particularly when they are inside with windows and doors closed and no air conditioning. They might not open windows and doors because they are afraid someone may break in and injure them.

Symptoms

• faintness,
• light headedness,
• dizziness,
• headache
• nausea.

Treatment

For heat cramps, treatment consists of moving the patient to a cool environment, providing rest, and administering oral or I.V. fluid and electrolyte replacement (for example, Lytren or Rehydralyte for adults and Pedialyte for children). Salt tablets aren't recommended because of their comparatively slow absorption rate.

Treatment for heat exhaustion involves moving the patient to a cool environment, providing rest, and administering oral fluid and electrolyte replacement. If I.V. fluid replacement is necessary, laboratory test results determine the choice of I.V. solution - usually saline or isotonic glucose solution.

Heatstroke therapy focuses on lowering the body temperature as rapidly as possible. The patient's clothing is removed and cool water is applied to the skin, followed by fanning with cool air. Shivering is controlled with diazepam or chlorpromazine. Application of hypothermia blankets and ice packs to the groin and axillae also helps lower body temperature. Treatment continues until the body temperature drops to 102.20 F (390 C). Supportive measures include oxygen therapy, central venous pressure and pulmonary artery wedge pressure monitoring, and, if necessary, endotracheal intubation. The patient is closely observed for complications.

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