Tuesday, September 2, 2014

Heat Illness

By : Dr. Terri Coco is a pediatric emergency medicine specialist at Children’s of Alabama and an associate professor at UAB. Her area of interest is injury prevention.

Every summer stories appear in the media about children gaining access to or being left in hot vehicles. It’s a nationwide tragedy and, unfortunately, not uncommon. As of July of this year, there were 23 heatstroke deaths of children who had been left in cars. Last year, these fatalities totaled 44, according to researchers at San Francisco State University. A total of 630 children have died this way since 1998.

This is terribly sad on many levels, with most of these deaths being preventable. And while we are thankful that we don’t diagnose much heat stroke in the Children’s Emergency Department, we do occasionally treat heat exhaustion. This is, after all, the South, where we get high humidity along with high temperatures. Children who are outside for long periods of time participating in organized sports need to get plenty of water and electrolytes, which are contained in sports drinks. Getting dehydrated exacerbates heat illness and heat exhaustion. Young children and adolescents need to wear proper clothing, be given periodic breaks and be monitored for symptoms of heat exhaustion, which can develop into deadly heat stroke.

It’s difficult to say precisely when and where pediatricians can effectively educate patients about the dangers of heat stroke—or hyperthermia—to their patients and caregivers. Perhaps a good time would be during a well child check, or while discussing car safety. Also, many good articles have been written that provide parents with helpful tips such as creating reminders by putting something like a purse or briefcase in the back seat next to a child.

It’s important to understand that this danger exists in even moderate temperatures. Of course, heat stroke can strike anybody. Young children and infants are just more susceptible to it because they have less ability to regulate their core body temperature. Consider the basic biology of hyperthermia, and its three progressive stages:

1. Heat stress. That is simply the discomfort we feel when we are exposed to heat. Generally, it’s harmless but uncomfortable, especially if we drink plenty of fluids and don’t overdo it.

2. Heat exhaustion. This is where heat illness becomes mild to moderate and unhealthy. It is often associated with dehydration along with achy joints and rising temperature, similar to a flu-like illness. Symptoms can include: intense thirst, fainting, dizziness, vomiting, weakness, discomfort, anxiety, confusion, headache and flush, dry skin. People suffering from heat exhaustion should been seen by a physician.

3. Heat stroke. In this is the final stage of heat illness, a person’s temperature skyrockets to over 104 degrees, and their central nervous system malfunctions. Organs begin failing. Delirium, convulsions, coma and death can follow.

Treatment for heat exhaustion is fluids and being removed from a hot environment. The person should be cooled down with wet rags and ice packs, especially in neck, groin and under the arms. This will help lower the core body temperature. Evaluation by a physician is recommended to prevent the progression to heat stroke.

There is one other condition worth mentioning, although it’s not considered a heat illness. It’s called rhabdomyolysis. We see it fairly often in young people, and it can be caused by exercising too much, or over-exertion without enough hydration. Essentially, the red blood cells break down, and kidneys can fail. Symptoms may include muscle aches, stiffness or weakness, along with darkened urine. It can be serious.

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