Heatstroke Follow-up

  • Author: Robert S Helman, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Oct 26, 2010
 

Further Inpatient Care

Once the acute phase is stabilized, further inpatient care may be necessary to address the complications of heatstroke.

Next

Further Outpatient Care

Long-term outpatient therapy may be required when chronic renal failure develops and when irreversible damage to the CNS, lungs, heart, and liver occurs.

Previous
Next

Deterrence/Prevention

Heatstroke is a preventable illness, and education is the single most important tool for its prevention.

Recognition of host risk factors and modification of behavior (eg, limiting alcohol and drug intake, avoiding use of medications and drugs that interfere with heat dissipation) and physical activity also can prevent heatstroke.

Previous
Next

Complications

Heatstroke is a multisystem insult that potentially can affect almost every organ system.

The CNS is especially sensitive to the damaging effects of hyperthermia. Widespread cell death occurs but is more evident in the region of the cerebellum (Purkinje cells). Heatstroke–related long-term CNS sequelae include cerebellar deficits, dementia, hemiplegia, quadriparesis, and personality changes.

In one study, rhabdomyolysis was observed in almost all patients with EHS and in as many as 86% of patients with NEHS. Compartment syndrome is observed most commonly in patients with severe rhabdomyolysis and in patients who are immobilized.

ARF may occur in as many as 25-30% of patients who have heatstroke (especially EHS).

Acute liver failure due to centrilobular hepatic necrosis and cholestasis generally occurs in the first 48 hours, but it can peak as long as 2 weeks after the onset of heatstroke. In rare instances, liver failure may be complicated by a fulminant course requiring liver transplantation. Patients who survive generally have a complete return of hepatic function.

DIC is a rare complication and caries a poor prognosis when it occurs. Electron microscopy studies have shown that direct thermal injury to the vascular endothelium is the primary trigger of platelet aggregation and, possibly, DIC.

ARDS may be due to direct thermal injury to the lung, or it may complicate liver failure, infection, or aspiration. When associated with liver failure, the patient prognosis is much worse.

Previous
Next

Prognosis

Indicators of poor prognosis during acute episodes include the following:

  • Initial temperature measurement higher than 41°C or a temperature higher than 108°F or a temperature persisting above 102°F despite aggressive cooling measures
  • Coma duration longer than 2 hours
  • Severe pulmonary edema
  • Delayed or prolonged hypotension
  • Lactic acidosis in patients with classic heatstroke
  • ARF and hyperkalemia
  • Aminotransferase levels greater than 1000 IU/L during the first 24 hours
Previous
Next

Patient Education

Education is the single most important tool for the prevention of heatstroke.

The media, public education, public health programs, and athlete safety programs can play a pivotal role in increasing the public's awareness of the dangers of heat during heat waves and advising the public on methods of remaining cool.

Similarly, drinking fluids on schedule (and not based only on thirst), frequent cooling breaks, and frequent visits to air-conditioned places are very important because even short stays in an air-conditioned environment may drastically reduce the incidence of heatstroke.

Recognition of host risk factors and modification of behavior (eg, limiting alcohol and drug intake and the use of medications and drugs that interfere with heat dissipation) and physical activity also will prevent heatstroke.

For excellent patient education resources, visit eMedicine's Environmental Exposures and Injuries Center and Exercise, Nutrition, and Weight Management Center. Also, see eMedicine's patient education articles Heat Exhaustion and Heat Stroke and Heat Cramps.

Previous
 
Contributor Information and Disclosures
Author

Robert S Helman, MD  Director, Department of Emergency Medicine, Peninsula Hospital Center

Disclosure: Nothing to disclose.

Coauthor(s)

Rania Habal, MD  Assistant Professor, Department of Emergency Medicine, New York Medical College

Disclosure: Nothing to disclose.

Specialty Editor Board

Laurie Robin Grier, MD  Medical Director of MICU, Professor of Medicine, Department of Emergency Medicine, Anesthesiology and OBGYN, Section of Pulmonary and Critical Care Medicine, Louisiana State University Health Science Center at Shreveport

Laurie Robin Grier, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Society for Parenteral and Enteral Nutrition, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H  Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California Keck School of Medicine

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Osler Society, American Thoracic Society, New York Academy of Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Centers for Disease Control and Prevention. Heat Waves. Available at http://www.cdc.gov/climatechange/effects/heat.htm. Accessed July 2009.

  2. Centers for Disease Control and Prevention. Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety. Updated July 31, 2009. Available at http://emergency.cdc.gov/disasters/extremeheat/heat_guide.asp.

  3. American College of Sports Medicine Joint Statement. National Athletic Trainers' Association. Inter-Association Task Force on Exertional Heat Illnesses Consensus Statement. 2003. Available at http://www.nata.org/sites/default/files/inter-association-task-force-exertional-heat-illness.pdf. Accessed August 13, 2010.

  4. Heled Y, Rav-Acha M, Shani Y, Epstein Y, Moran DS. The "golden hour" for heatstroke treatment. Mil Med. Mar 2004;169(3):184-6. [Medline].

  5. Bouchama A, Dehbi M, Chaves-Carballo E. Cooling and hemodynamic management in heatstroke: practical recommendations. Critical Care 2007 [serial online]. 05/12/07;11 (issue 3):1-17. Accessed 02/03/07. Available at http://ccforum.com/content/11/3/R54.

  6. Ash CJ, Cook JR, McMurry TA, Auner CR. The use of rectal temperature to monitor heat stroke. Mo Med. May 1992;89(5):283-8. [Medline].

  7. Akhtar MJ, al-Nozha M, al-Harthi S, Nouh MS. Electrocardiographic abnormalities in patients with heat stroke. Chest. Aug 1993;104(2):411-4. [Medline].

  8. Armstrong LE, De Luca JP, Hubbard RW. Time course of recovery and heat acclimation ability of prior exertional heatstroke patients. Med Sci Sports Exerc. Feb 1990;22(1):36-48. [Medline].

  9. Bouchama A, Cafege A, Devol EB, Labdi O, el-Assil K, Seraj M. Ineffectiveness of dantrolene sodium in the treatment of heatstroke. Crit Care Med. Feb 1991;19(2):176-80. [Medline].

  10. Bouchama A, Hammami MM, Haq A, Jackson J, al-Sedairy S. Evidence for endothelial cell activation/injury in heatstroke. Crit Care Med. Jul 1996;24(7):1173-8. [Medline].

  11. Bouchama A, Knochel JP. Heat stroke. N Engl J Med. Jun 20 2002;346(25):1978-88. [Medline].

  12. Chou YT, Lai ST, Lee CC, Lin MT. Hypothermia attenuates circulatory shock and cerebral ischemia in experimental heatstroke. Shock. Apr 2003;19(4):388-93. [Medline].

  13. Costrini A. Emergency treatment of exertional heatstroke and comparison of whole body cooling techniques. Med Sci Sports Exerc. Feb 1990;22(1):15-8. [Medline].

  14. Dahmash NS, al Harthi SS, Akhtar J. Invasive evaluation of patients with heat stroke. Chest. Apr 1993;103(4):1210-4. [Medline].

  15. Easterling DR, Meehl GA, Parmesan C, Changnon SA, Karl TR, Mearns LO. Climate extremes: observations, modeling, and impacts. Science. Sep 22 2000;289(5487):2068-74. [Medline].

  16. Eichner ER. Treatment of suspected heat illness. Int J Sports Med. Jun 1998;19 Suppl 2:S150-3. [Medline].

  17. el-Kassimi FA, Al-Mashhadani S, Abdullah AK, Akhtar J. Adult respiratory distress syndrome and disseminated intravascular coagulation complicating heat stroke. Chest. Oct 1986;90(4):571-4. [Medline].

  18. Epstein Y, Moran DS, Shapiro Y, Sohar E, Shemer J. Exertional heat stroke: a case series. Med Sci Sports Exerc. Feb 1999;31(2):224-8. [Medline].

  19. Fish PD, Bennett GC, Millard PH. Heatwave morbidity and mortality in old age. Age Ageing. Jul 1985;14(4):243-5. [Medline].

  20. Hassanein T, Razack A, Gavaler JS, Van Thiel DH. Heatstroke: its clinical and pathological presentation, with particular attention to the liver. Am J Gastroenterol. Oct 1992;87(10):1382-9. [Medline].

  21. Howe AS, Boden BP. Heat-related illness in athletes. Am J Sports Med. Aug 2007;35(8):1384-95. [Medline].

  22. Hubbard RW. The role of exercise in the etiology of exertional heatstroke. Med Sci Sports Exerc. Feb 1990;22(1):2-5. [Medline].

  23. Hubbard RW, Gaffin SL, Squire DL. Heat-related illnesses. In: Auerbach P, ed. Wilderness Medicine: Management of Wilderness and Environmental Emergencies. 3rd ed. St. Louis, Mo: Mosby Year Book; 1995:167-212.

  24. Hubbard RW, Matthew CB, Durkot MJ, Francesconi RP. Novel approaches to the pathophysiology of heatstroke: the energy depletion model. Ann Emerg Med. Sep 1987;16(9):1066-75. [Medline].

  25. Khogali M, Weiner JS. Heat stroke: report on 18 cases. Lancet. Aug 9 1980;2(8189):276-8. [Medline].

  26. Kilbourne EM, Choi K, Jones TS, Thacker SB. Risk factors for heatstroke. A case-control study. JAMA. Jun 25 1982;247(24):3332-6. [Medline].

  27. Kumar S. India's heat wave and rain result in massive death toll. Lancet. 1998;351, No. 9119.

  28. Lomax P, Schonbaum E. The effects of drugs on thermoregulation during exposure to hot environments. Prog Brain Res. 1998;115:193-204. [Medline].

  29. MMWR. Heat-related illnesses, deaths, and risk factors--Cincinnati and Dayton, Ohio, 1999, and United States, 1979-1997. MMWR Morb Mortal Wkly Rep. Jun 2 2000;49(21):470-3. [Medline].

  30. Raju SF, Robinson GH, Bower JD. The pathogenesis of acute renal failure in heat stroke. South Med J. Mar 1973;66(3):330-3. [Medline].

  31. Shapiro Y, Seidman DS. Field and clinical observations of exertional heat stroke patients. Med Sci Sports Exerc. Feb 1990;22(1):6-14. [Medline].

  32. Shibolet S, Lancaster MC, Danon Y. Heat stroke: a review. Aviat Space Environ Med. Mar 1976;47(3):280-301. [Medline].

  33. Squire DL. Heat illness. Fluid and electrolyte issues for pediatric and adolescent athletes. Pediatr Clin North Am. Oct 1990;37(5):1085-109. [Medline].

  34. Tek D, Olshaker JS. Heat illness. Emerg Med Clin North Am. May 1992;10(2):299-310. [Medline].

  35. Tucker LE, Stanford J, Graves B, Swetnam J, Hamburger S, Anwar A. Classical heatstroke: clinical and laboratory assessment. South Med J. Jan 1985;78(1):20-5. [Medline].

  36. Vassalo SU, Delaney KA. Thermoregulatory principles. In: Goldfrank's Toxicologic Emergencies. Stamford, Conn: Appleton & Lange; 1998:285-307.

  37. Vicario SJ, Okabajue R, Haltom T. Rapid cooling in classic heatstroke: effect on mortality rates. Am J Emerg Med. Sep 1986;4(5):394-8. [Medline].

  38. White JD, Riccobene E, Nucci R, Johnson C, Butterfield AB, Kamath R. Evaporation versus iced gastric lavage treatment of heatstroke: comparative efficacy in a canine model. Crit Care Med. Aug 1987;15(8):748-50. [Medline].

  39. Yang YL, Lin MT. Heat shock protein expression protects against cerebral ischemia and monoamine overload in rat heatstroke. Am J Physiol. 1999;276:H1961-H1967.

  40. Yaqub B, Al Deeb S. Heat strokes: aetiopathogenesis, neurological characteristics, treatment and outcome. J Neurol Sci. Apr 1 1998;156(2):144-51. [Medline].

  41. Yaqub BA, Al-Harthi SS, Al-Orainey IO, Laajam MA, Obeid MT. Heat stroke at the Mekkah pilgrimage: clinical characteristics and course of 30 patients. Q J Med. May 1986;59(229):523-30. [Medline].

  42. Yarbrough B, Bradham A. Heat illness. In: Emergency Medicine: Concepts and Clinical Practice. 1998. 4th ed. St Louis, Mo: Mosby Year Book; 1998:986-1002.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.