High Temperature Disorders - Heat Syncope (Heat Collapse) And Water Depletion Heat Exhaustion
By Funom Makama
Heat syncope (Heat collapse)
Heat syncope may occur in a hot environment in the absence of demonstrable water and salt depletion. Heat syncope may occur in a wide range of temperatures, not necessarily the highest. The condition may affect newcomers of the natives in the locality, doing excessive physical exertion. Syncope results from pooling of blood in the blood vessels of the muscles and skin, especially of the lower limbs, during or after physical activity.
Clinical features: Syncope or collapse occurs either during or immediately after heat exposure on prolonged standing or sudden change of posture. Giddiness, vertigo, and nausea are common. The patient is pae with shallow breathing and frequent yawning. The blood pressure is low and the pulse is slowed as in vasovagal syncope. The symptoms may pass off in a few minutes after sitting or lying down. Rapid recovery occurs if the patient is transferred to cool environment.
Diagnosis: Syncope with postural changes during or immediately after heat exposure, without demonstrable water or salt depletion and the rapid recovery of the patient are diagnostic.
Treatment: The patient should be transported to a cool room and put to bed. Adequate fluids in the form of simple beverages should be given and urine output should be encouraged to take adequate amounts of salt (15-20g/day) to avoid recurrence.
Water depletion heat exhaustion
This type of dehydration is caused by inadequate intake of water and other fluids. This is usually sweating which leads to considerable loss of water. Children are more susceptible to the disorder than adults. The major factor is water deprivation which may be due to insufficient provision of water at the place of work, or voluntary avoidance of fluids in between meals. Negative water balance develops in persons doing heavy manual work in hot environment due to excessive sweating. From 6 to 8 liters of sweat may be lost in a day. Loss of water leads to reduction in the volume and increase in the osmolarity of the extracellular fluid. Intracellular water moves into the extracellular compartment. Salt depletion does not occur if salt intake is adequate, otherwise hyponatremia also develops.
Clinical features: Severe thirst is experienced in the early stages. The patient sweats even when the extremities are cold (cold moist man). Other early symptoms are non-specific such as dryness of the mouth, irritability, restlessness, and weakness. In the fully established case dysphagia, hoarseness of voice, tachycardia, hypertension, oliguria and anuria follow. Untreated, mental changes such as delirium and coma supervene and the condition may end fatally.
Diagnosis: The circumstances under which this syndrome occurs viz, the high environmental temperature and the clinical picture, especially with intense thirst, are diagnostic in a conscious patient. Difficulties arise in comatose patients who are also febrile. Distinction from salt deficiency may be difficult but the high sodium content of urine and plasma help in distinguishing pure water depletion state.
treatment:Patient should be kept at rest in a cool room. In mild cases oral fluids and flavored drinks are adequate. In sever cases, the oral intake should be 5-8 liters on the first day with 15-20g sodium chloride. In an unconscious patient 4-5 liters of 5% dextrose solution are given intravenously in the first 24 hours with close monitoring of urine output. The levels of serum sodium and urinary sodium and chloride should be estimated and deficiencies should be corrected. Increasing urine output, rise of blood pressure and return of weight to normal are indications of clinical recovery.
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