Heat exhaustion and heat stroke should be differentiated promptly

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Most parts of the country are experiencing high temperatures. With the ongoing heat wave, cases of heat–related disorders are also bound to increase. Heat cramps, heat exhaustion and heat stroke are the three forms of heat-related disorders that occur with prolonged exposure to heat and differ in their severity. Hence, it is important to differentiate between the three conditions.

Clinically, both heat exhaustion and heat stroke may manifest as fever, dehydration and other symptoms such as headache, thirst, malaise, nausea or vomiting, rapid pulse etc. The main difference between heat exhaustion and heat stroke is the presence of sweat in the former and absence in the latter.’

Normally, the axillae will always be wet even if a person has severe dehydration. If the axillae are dry and the person has high fever, this invariably means that the person has progressed from heat exhaustion to heat stroke and this should be treated as a medical emergency.

In heat exhaustion, the core temperature is between 37°C and 40°C. While in heat stroke, the core temperature is very high, > 400C and needs to be lowered within minutes and not hours. Rapid reduction in body temperature can be accomplished by cool or tepid bathing preferably using damp sponges. Submersion should be avoided so that body heat loss by evaporation can occur. Cooling blankets should also be avoided.

The absence of sweating, dry armpit, non-passage of urine for 8 hours or presence of high grade fever in summer seasonare ‘red flags’ and medical attention should be sought immediately.

Heat cramps are muscle spasms in the arms, legs, or abdomen that result from loss of large amount of salt and water through exercise. The treatment is replacing fluid and salt orally.

Dr KK Aggarwal
National President IMA & HCFI