A Family Doctor's Tale - HEAT STROKE

DOC I HAVE HEAT STROKE

Heat Stroke is a disturbance of the heat regulating mechanism of the body which can result in hyperpyrexia (high body temperature), syncope(fainting), convulsions (fits), coma and sometimes death


This is common with
1.people staying in hot dry climates (eg desert)


2.People training under hot temperature (eg soldiers)


3.During heat waves.


Most forms of Heat Stroke are due to


Genetic conditions:
------------------------
Ichthyosis (  A Simple Guide to Ichthyosis )
(dry scaly skin covering the body)


Acquired Heat Stroke
-----------------------------

1.Body's inability to dissipate body heat


2.Strenuous exercise without sufficient hydration


3.Prolonged exposure to high temperatures especially sunshine especially in desert and heat waves


4.Dehydration and inability to sweat.


5.Medicines which reduce sweating:
anticholinergics
antidepressants
MAO inhibitors


Onset is usually sudden after exposure to sun and heat resulting in Symptoms:

1.feeling of weakness


2.dizziness and nausea


3.headache


4.chest discomfort


5.flushing of face and body


Signs:


1.Fever


2.Flushed skin


3.Muscle twitching


4.Muscle cramps


5.Tachycardia (fast heart beats), raised blood pressure


6.Dilated pupils


7.Reduced reflexes


8.Seizures and coma


9.Hyperventilation


10.Heart failure



A diagnosis of Heat Stroke is usually based on:

1.History of exposure to high temperature


2.High body temperature


3.Blood electrolytes and acid base


Prolonged heat stroke may result in:

1.Brain damage


2.Heart damage


3.Kidney damage



Heat Stroke is a life threatening emergency and should be treated urgently.

1.Reduce temperature with ice packs or ice baths


2.Alcohol sponging if ice not available

In the Singapore Army, there is a prickly heat powder bath which can cool the body down when water is not available for baths.


3.Cooler packs if available


4.Intravenous fluids to correct dehydration and electrolytes


5.Oral fluids and isotonic drinks.


6.Anticonvulsant to prevent seizure or fits


Prognosis is poor if treatment is delayed.


Treat the condition urgently as it is a life threatening emergency.


Prevention is by

1.frequent drinking of water 

Water parades are daily routines in the Singapore Army where the soldiers or recruits lined up to take their daily 2 liters of water as a prevention against heat stroke.



2.avoiding extreme hot temperature.