Heat Exhaustion and Heatstroke: Awareness, Prevention, Diagnosis and Treatment

Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

The Husband is playing golf again on a regular basis, after years of playing only a few times a year. He takes a lesson each week with a club pro and works on small changes to his stance, grip, swing and all the many important parts of successful golf skills necessary to moving that tiny white ball effortlessly straight and just the right distance. Last weekend he left after breakfast to practice and play nine holes and did not return until 3 p.m. It was 90 degrees in the shade from noon till three. When he arrived home, he was soaked with sweat, sunburned, tremulous, exhausted and clearly suffering from heat exhaustion. He reported that he realized that he was “in trouble” when he was on the 7th hole of the nine-hole course. In response to my reasonable question, “Why didn’t you just stop playing and come home?” He replied, “ I was drinking lots of water and I had to walk back to the clubhouse anyway, so I thought I might as well play on through.” Clearly the heat had diminished his cognitive function. I put him in a cool shower for thirty minutes and slowly gave him small amounts of Gatorade and water (to replenish loss of electrolytes from prolonged sweating). He recovered, though he was exhausted for the rest of the afternoon and evening.

Heatstroke and heat exhaustion affect those other than the elderly, the frail, the ill, or the very young. Heatstroke also affects the weekend athlete or gardener and those that must work outdoors, unaware of the dangers of being outside for a prolonged time in hot weather.

“Heatstroke” is a colloquial term used to describe two distinct entities:

(1) Severe nonexertional hyperthermia (overheating of the body), which generally affects the very young, the disabled, the poor, those who are isolated because of mental illness, or the elderly.

(2) Exertional heat illness, which mostly affects otherwise healthy adults and adolescents.

These two groups are linked due to underlying causes and effects (too much heat or sun exposure and a lack of hydration) and the eventual health impact (extreme elevations of body temperature leading to bodily dysfunction). Heat exhaustion sometimes occurs when a person exercises or works in a hot environment and the body cannot cool itself adequately. Dehydration occurs with water loss from excessive sweating, which causes muscle cramps and weakness, along with nausea and vomiting. This makes it difficult to drink enough fluid to replenish the body’s water supply. This lack of water  further impairs sweating, evaporation and cooling. If the humidity is too high, sweat on the skin cannot evaporate into the surrounding air and body temperature cooling fails.

Heat exhaustion and heatstroke are caused by environmental conditions. As outside temperatures rise, the body reacts by sweating. This evaporation of water from the skin and respiratory tract is the most effective way of ridding the body of excess heat. Less effective reduction in heat occurs from the direct radiation of heat into the environment, the transfer of heat to air or liquids moving over the body. These normal cooling mechanisms become ineffective when humidity rises above 75 percent and air temperature rises above normal body temperature.

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  • Lgibbons July 16, 2017 at 8:25 am

    Wonderful advice.