Heat stroke is a medical emergency where the body’s heat regulatory mechanisms fail and the body temperature rises to 104 degrees or higher. This condition is potentially life threatening since the elevated body temperature can produce damage to tissues, organs and body systems.
Heat exhaustion is a clinical entity where adolescents become dehydrated during conditions of heat stress. This usually occurs when there is inadequate replacement of fluids during athletics or other types of heavy exertion; it may occasionally happen when large amounts of perspiration loss are replaced with water that has an inadequate amount of salt. In heat exhaustion there is no significant elevation of body temperature and this is an important differentiation between heat exhaustion and the more dangerous heat stroke.
It is not totally clear why the body’s heat regulation fails in heat stroke. Some experts hypothesize that the cellular mechanisms that produce energy to sustain the thermoregulatory mechanisms become insufficient or fail during heat stroke. As energy is not produced to run these heat-regulating mechanisms, the core temperature of the body begins to rise. At a certain temperature, damage to tissues begins. The amount and severity of damage is not only a function of body temperature, but also the amount of time the body is exposed to high body temperature.
Who is likely to develop heat stroke?
Adolescents who have prolonged exposure to hot temperatures may be prone to heat stroke. In particular, heat stroke may occur during exertion in young healthy teenagers. These teens may have certain risk factors including obesity, a concurrent illness with fever, diarrhea or poor fluid intake. Other contributing factors may include a high environmental temperature and humidity, inappropriate clothing for the temperature and conditions and an inadequate salt intake.
What are the symptoms of heat stroke?
One should think of heat stroke as a spectrum that begins with heat exhaustion. In heat exhaustion, symptoms include fatigue, headache, low blood pressure, dehydration and headache. Mental function is usually intact in heat exhaustion and the body temperature is normal, or at least below 104 degrees.
In heat stroke, symptoms are more severe. The body temperature is 104 degrees or more, and there are signs of mental dysfunction. In particular, teens first may become delirious, then develop seizures and then become comatose. Other symptoms may include weakness, dizziness, nausea, vomiting, confusion, disorientation, muscle twitching, mood changes and difficulty in walking a straight line. Adolescents who have heat stroke may have hot and dry skin without signs of sweating. This is an indication that the thermoregulatory mechanisms have failed. Without sweating the body temperature will continue to rise.
Teens who develop heat stroke from heavy exertion due so primarily from overwhelming amounts of heat produced by the body and inadequate ways to disperse the heat. Muscle damage occurs from excessive heat and this may lead to kidney failure. Liver and brain damage may ensue.
Some adolescents who use Ecstasy, a designer drug, and participate in raves have been reported to suffer from heat stroke. These teens develop high body temperature, rhythm disturbances of the heart, blood coagulation problems, muscle destruction and kidney failure. Fatalities have been widely reported in England and the United States from heat stroke due to use of Ecstasy.
How is heat stroke evaluated?
Since heat stroke is a medical emergency, medical personnel should evaluate the teen with suspected heat stroke quickly. A complete medical assessment including physical examination and laboratory tests are usually provided. Needless to say, body temperature, blood pressure, pulse rate and complete evaluation of the patient’s mental status is important. Laboratory tests including urine and blood specimens are also obtained
How is heat stroke treated?
Medical personnel will initially attempt to stabilize the adolescent with heat stroke. The teen must be cooled down as quickly as possible since the longer the teen has high temperature the more likely he or she will succumb to the illness. Some hospitals cool patients in ice water and this brings down very elevated body temperature to 102.2 degrees or less within ten to forty minutes. In the military where sixty-six patients who developed heat stroke from heavy exertion were studied, all were saved by immersion in ice water. Other methods of cooling the body include surrounding the teen with ice packs or a cooling blanket.
Since adolescents with heat stroke are dehydrated and usually have low blood pressure, then intravenous fluids are administered. Occasionally adolescents need assisted respiration from a ventilator. If seizures occur, then ant seizure medications are administered.
How is heat stroke prevented?
Adolescents are most at risk for heat stroke when they have heavy exertion over a prolonged period during high heat. During the Boston Marathon, a 26.2 mile run, water is offered to runners every mile. And experienced runners say that marathoners should drink a cup of water every mile.
Proper fluid intake during heavy exertion is the best preventive measure adolescents can take to prevent heat stroke. Drinking cold rather than lukewarm fluid encourages the stomach to empty the fluid rapidly into the small intestine. The fluids may be water or a weak electrolyte solution. Avoid solutions with excessive sugar since these fluids impede rapid entry into the small intestine. Some suggest drinking one pint of fluid before exertion, then around eight ounces every twenty minutes during exertion in order to prevent dehydration.
Some authorities advocate weighing the adolescent before and after training or an athletic event. The difference in weight should be replaced with proper fluids. For example, if a teen loses two pounds during a competition, he or she should drink one quart of an appropriate fluid. Most authorities do not recommend that teens take salt tablets during heavy exertion. Salt tablets may interfere with the stomach’s ability to empty water into the small intestine, cause damage to the stomach lining and also shift fluid away from the blood stream and into the gut.
During heavy exertion, an adolescent should wear clothing that allows him or her to perspire appropriately. Loose fitting clothing or fish net jerseys are helpful as well as light colored clothing that will reflect rather than absorb light. Teens should have a buddy, coach or other adult check them for early signs of heat exhaustion or heat stroke. Teens need to be aware that heat stroke can occur in individuals who use ecstasy and participate in raves. Also excessive use of alcohol may be a factor that can lead to heat stroke in that a teen may become dehydrated as a result of drinking.
Related topics:
Alcohol, exercise, military service, obesity, party drugs, seizures, sports
