Heat disorders are a group of physically related illnesses caused by prolonged exposure to hot temperatures, restricted fluid intake, or failure of temperature regulation mechanisms of the body. Disorders of heat exposure include heat cramps, heat exhaustion, and heat stroke (also called sunstroke). Hyperthermia is the general name given to heat-related illnesses. The two most common forms of hyperthermia are heat exhaustion and heat stroke, which is especially dangerous and requires immediate medical attention.
Heat disorders are harmful to people of all ages, but their severity is likely to increase as people age. Heat cramps in a 16-year-old may be heat exhaustion in a 45-year-old and heat stroke in a 65-year-old. The body's temperature regulating mechanisms rely on the thermal regulating centers in the brain. Through these complex centers, the body tries to adapt to high temperatures by adjusting the amount of salt in the perspiration. Salt helps the cells in body tissues retain water. In hot weather, a healthy body will lose enough water to cool the body while creating the lowest level of chemical imbalance. Regardless of extreme weather conditions, the healthy human body keeps a steady temperature of approximately 98.6°F (37°C). In hot weather, or during vigorous activity, the body perspires. As perspiration evaporates from the skin, the body is cooled. If the body loses too much salt and fluids, the symptoms of dehydration can occur.
Heat cramps are the least severe of the heat-related illnesses. This heat disorder is often the first signal that the body is having difficulty with increased temperature. Individuals exposed to excessive heat should think of heat cramps as a warning sign to a potential heat-related emergency.
Heat exhaustion is a more serious and complex condition than heat cramps. Heat exhaustion can result from prolonged exposure to hot temperatures, restricted fluid intake, or failure of temperature regulation mechanisms of the body. It often affects athletes, firefighters, construction workers, factory workers, and anyone who wears heavy clothing in hot humid weather.
Heat exhaustion can develop rapidly into heat stroke. Heat stroke can be life threatening and because the percentage of victims dying from heat stroke is very high, immediate medical attention is critical when problems first begin. Heat stroke, like heat exhaustion, is also a result of prolonged exposure to hot temperatures, restricted fluid intake, or failure of temperature regulation mechanisms of the body. However, the severity of impact on the body is much greater with heat stroke.
Causes and symptoms
Heat cramps are painful muscle spasms caused by the excessive loss of salts (electrolytes), due to heavy perspiration. The muscle tissue becomes less flexible, causing pain, difficult movement, and involuntary tightness. Heavy exertion in extreme heat, restricted fluid intake, or failure of temperature regulation mechanisms of the body may lead to heat cramps. This disorder occurs more often in the legs and abdomen than in other areas of the body. Individuals at higher risk are those working in extreme heat, elderly people, young children, people with health problems, and those who are unable to naturally and properly cool their bodies. Individuals with poor circulation and who take medications to reduce excess body fluids can be at risk when conditions are hot and humid.
Heat exhaustion is caused by exposure to high heat and humidity for many hours, resulting in excessive loss of fluids and salts through heavy perspiration. The skin may appear cool, moist, and pale. The individual may complain of headache and nausea with a feeling of overall weakness and exhaustion. Dizziness, faintness, and mental confusion are often present, as is rapid and weak pulse. Breathing becomes fast and shallow. Fluid loss reduces blood volume and lowers blood pressure. Yellow or orange urine often is a result of inadequate fluid intake, along with associated intense thirst. Insufficient water and salt intake or a deficiency in the production of sweat place an individual at high risk for heat exhaustion.
Heat stroke is caused by overexposure to extreme heat, resulting in a breakdown in the body's heat regulating mechanisms. The body's temperature reaches a dangerous level, as high as 106°F (41.1°C). An individual with heat stroke has a body temperature higher than 104°F (40°C). Other symptoms include mental confusion with possible combativeness and bizarre behavior, staggering, and faintness.
The pulse becomes strong and rapid (160-180 beats per minute) with the skin taking on a dry and flushed appearance. There is often very little perspiration. The individual can quickly lose consciousness or have convulsions. Before heat stroke, an individual suffers from heat exhaustion and the associated symptoms. When the body can no longer maintain a normal temperature, heat exhaustion becomes heat stroke. Heat stroke is a life-threatening medical emergency that requires immediate initiation of life-saving measures.
The diagnosis of heat cramps usually involves the observation of individual symptoms such as muscle cramping and thirst. Diagnosis of heat exhaustion or heat stroke, however, may require a physician to review the medical history, document symptoms, and obtain a blood pressure and temperature reading. The physician may also take blood and urine samples for further laboratory testing. A test to measure the body's electrolytes can also give valuable information about chemical imbalances caused by the heat-related illness.
The care of heat cramps includes placing the individual at rest in a cool environment, while giving cool water with a teaspoon of salt per quart, or a commercial sports drink. Usually rest and liquids are all that is needed for the patient to recover. Mild stretching and massaging of the muscle area follows once the condition improves. The individual should not take salt tablets, since this may actually worsen the condition. When the cramps stop, the person can usually start activity again if there are no other signs of illness. The individual needs to continue drinking fluids and should be watched carefully for further signs of heat-related illnesses.
The individual suffering from heat exhaustion should stop all physical activity and move immediately to a cool place out of the sun, preferably a cool, air-conditioned location. She or he should then lay down with feet slightly elevated, remove or loosen clothing, and drink cold (but not iced), slightly salty water or commercial sports drink. Rest and replacement of fluids and salt is usually all the treatment that is needed, and hospitalization is rarely required. Following rehydration, the person usually recovers rapidly.
Simply moving the individual afflicted with heat stroke to a cooler place is not enough to reverse the internal overheating. Emergency medical assistance should be called immediately. While waiting for help to arrive, quick action to lower body temperature must take place. Treatment involves getting the victim to a cool place, loosening clothes or undressing the heat stroke victim, and allowing air to circulate around the body. The next important step is wrapping the individual in wet towels or clothing, and placing ice packs in areas with the greatest blood supply. These areas include the neck, under the arm and knees, and in the groin. Once the patient is under medical care, cooling treatments may continue as appropriate. The victim's body temperature will be monitored constantly to guard against overcooling. Breathing and heart rate will be monitored closely, and fluids and electrolytes will be replaced intravenously. Anti-convulsant drugs may be given. After severe heat stroke, bed rest may be recommended for several days.
Prompt treatment for heat cramps is usually very effective with the individual returning to activity thereafter. Treatment of heat exhaustion usually brings full recovery in one to two days. Heatstroke is a very serious condition and its outcome depends upon general health and age. Due to the high internal temperature of heat stroke, permanent damage to internal organs is possible.
Convulsions — Also termed seizures; a sudden violent contraction of a group of muscles.
Electrolytes — An element or compound that when melted or dissolved in water dissociates into ions and is able to conduct an electrical current. Careful and regular monitoring of electrolytes and intravenous replacement of fluid and electrolytes are part of the acute care in many illnesses.
Rehydration — The restoration of water or fluid to a body that has become dehydrated.
Because heat cramps, heat exhaustion, and heat stroke have a cascade effect on each other, the prevention of the onset of all heat disorders is similar. Avoid strenuous exercise when it is very hot. Individuals exposed to extreme heat conditions should drink plenty of fluids. Wearing light and loose-fitting clothing in hot weather is important, regardless of the activity. It is important to consume water often and not to wait until thirst develops. If perspiration is excessive, fluid intake should be increased. When urine output decreases, fluid intake should also increase. Eating lightly salted foods can help replace salts lost through perspiration. Ventilation in any working areas in warm weather must be adequate. This can be achieved as simply as opening a window or using an electric fan. Proper ventilation will promote adequate sweat evaporation to cool the skin. Sunblocks and sunscreens with a protection factor of 15 (SPF 15) can be very helpful when one is exposed to extreme direct sunlight.
Griffith, H. Winter. "Complete Guide to Symptoms, Illness & Surgery." ThriveOnline. http://thriveonline.oxygen.com.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
heat disordersBodily dysfunction resulting from exposure to excessive heat, from disorders of the heat regulating mechanisms or from the excessive production of body heat. The heat disorders include PRICKLY HEAT, heat cramps, HEAT EXHAUSTION and HEAT STROKE.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005