Are heat stroke patients fluid depleted? Importance of monitoring central venous pressure as a simple guideline for fluid therapy

Seraj, Mohamed A.; Channa, Amir B.; Harthi, S S al; Khan, Faisel; Zafrullah, A.; Samarkandi, Abdulhamid H.

doi:10.1016/0300-9572(91)90076-b

Cited by 35 publications

(30 citation statements)

References 9 publications

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“…Dehydration is more of an issue in longer-duration races, but need not be present to develop EHS (24,29,30). Cooling promotes extracellular fluid return to intravascular space, and careful fluid replacement should be utilized until the athlete is cooled and hydration status can be better judged or oral replacement can be accomplished (30). Diazepam, midazolam, or magnesium sulfate can be used to control shivering, seizures, or persistent muscle spasms.…”

Section: Discussionmentioning

confidence: 98%

“…The usual endpoint for cooling therapy is 39-C (102-F) to prevent overcooling (8,10,28), but there may be some advantage to overcooling as is now recommended in acute myocardial infarction. Dehydration is more of an issue in longer-duration races, but need not be present to develop EHS (24,29,30). Cooling promotes extracellular fluid return to intravascular space, and careful fluid replacement should be utilized until the athlete is cooled and hydration status can be better judged or oral replacement can be accomplished (30).…”

Section: Discussionmentioning

confidence: 99%

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Exertional Heat Stroke during a Cool Weather Marathon

Roberts

2006

Medicine &Amp; Science in Sports &Amp; Exercise

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A well-trained male runner in his late 30s collapsed 10 m before the finish line, nearly completing the 42.1-km marathon course in 3 h, 15 min. He was responsive to pain, agitated, diaphoretic, and unable to walk. The race start temperature was 6 degrees C (43 degrees F) with relative humidity of 99% and the 3-h temperature was 9.5 degrees C (49 degrees F) with a 62% relative humidity. Approximately 27 min after his collapse, his rectal temperature in the emergency department was 40.7 degrees C (105.3 degrees F), and his failing respiratory status required intubation. His initial Glasgow coma score was 6-7 of 15. His renal output was minimal until he was cooled and given a large fluid flush. His initial echocardiogram showed a "stunned" myocardium with an ejection fraction of 35%. He had a viral syndrome the week prior to the race and was paced by a "fresh" runner the last 16 km of the race. He left the hospital in 5 d and has now returned to running without problems, although several months passed before he felt well while exercising. Exertional heat stroke can occur in cool conditions, and rectal temperature should be checked in all collapsed runners who do not progress with rapid recovery of vital signs and cognitive function. Runners should be instructed not to compete when ill and should not use nonparticipant pacers during the runs.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Exertional Heat Stroke during a Cool Weather Marathon

Roberts

2006

Medicine &Amp; Science in Sports &Amp; Exercise

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“…Tachycardia and tachypnea are common and accompanied by hypotension in approximately one third of classic heat stroke cases (42). More detailed cardiac abnormalities have been reported in heat stroke patients than animal models and include PVCs, ST segment depression, and T-wave changes consistent with myocardial ischemia and infarction, sinus tachycardia, and hypo-or hypertension that present with or without global myocardial damage (7,9,85,182,238,335,337,342,346,414). Hypocalcemia and hyperkalemia have been implicated in Q-T interval prolongation and S-T segment abnormalities, respectively, with heat stroke (7,190).…”

Section: Cardiovascular Dysfunction With Heat Strokementioning

confidence: 95%

Heat Stroke

Leon

Bouchama

2015

Comprehensive Physiology

360

356

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Heat stroke is a life-threatening condition clinically diagnosed as a severe elevation in body temperature with central nervous system dysfunction that often includes combativeness, delirium, seizures, and coma. Classic heat stroke primarily occurs in immunocompromised individuals during annual heat waves. Exertional heat stroke is observed in young fit individuals performing strenuous physical activity in hot or temperature environments. Long-term consequences of heat stroke are thought to be due to a systemic inflammatory response syndrome. This article provides a comprehensive review of recent advances in the identification of risk factors that predispose to heat stroke, the role of endotoxin and cytokines in mediation of multi-organ damage, the incidence of hypothermia and fever during heat stroke recovery, clinical biomarkers of organ damage severity, and protective cooling strategies. Risk factors include environmental factors, medications, drug use, compromised health status, and genetic conditions. The role of endotoxin and cytokines is discussed in the framework of research conducted over 30 years ago that requires reassessment to more clearly identify the role of these factors in the systemic inflammatory response syndrome. We challenge the notion that hypothalamic damage is responsible for thermoregulatory disturbances during heat stroke recovery and highlight recent advances in our understanding of the regulated nature of these responses. The need for more sensitive clinical biomarkers of organ damage is examined. Conventional and emerging cooling methods are discussed with reference to protection against peripheral organ damage and selective brain cooling.

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“…[4][5][6]19,20 Extreme heat affects performance and productivity and predisposes people to societal conflicts, violent crimes, and civil wars. 2,[21][22][23][24] The emerging incidence of heat illnesses in the backdrop of pre-existing morbidities and complications thereof needs active surveillance and threat assessment with pre-determined mathematical models comparable to those of cold injury and altitude illnesses. [25][26][27][28] This study was conducted in limited resource tent-clinics, which prevented the detailed assessment of heat illness, complications, differential diagnoses, and documentation due to the overwhelming throughput of patients.…”

Section: Discussionmentioning

confidence: 99%