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- David S. Jardine, MD*
- *Children's Hospital, Seattle, Wash
Objectives
After completing this article, readers should be able to:
Describe the laboratory abnormalities that accompany heat stroke.
Understand the relationship between core temperature and injury.
Discuss strategies to reduce the risk of heat stroke during athletic events.
Describe the physical findings of patients suffering from heat stroke.
List the most common sequelae of heat stroke.
Identify the body temperature above which heat injury begins to occur.
Explain the differences between malignant hyperthermia and heat stroke.
Discuss the differences between heat stress, heat exhaustion, and heat stroke.
Introduction
Heat illness is caused by an inability to maintain normal body temperature because of excess heat production or decreased heat transfer to the environment. Heat stroke arises when cellular injury is caused by excess body temperature. If the core temperature rises above 105.8°F (41°C) for more than a short time, thermal injury results. Proteins are denatured, and injured cells undergo apoptosis (programmed cell death) or necrosis. Even before injury takes place, an individual may suffer transient mental and physical impairment, which is called heat exhaustion. Heat stroke is a medical emergency that is associated with a mortality of approximately 12% in adult patients. Treatment requires aggressive supportive care to minimize mortality.
It is important to recognize the difference between fever and heat stroke. Fever is a normal response, during which the core temperature remains under the control of the central thermoregulatory centers that reside in the hypothalamus and brainstem. When a pyrogenic stimulus is received, core temperature is elevated rapidly to a new set point that is regulated by normal mechanisms. Maximum febrile temperatures rarely exceed 105.8°F (41°C). (1) In contrast, during heat illness, normal heat transfer mechanisms are overwhelmed and central thermoregulatory control is ineffective. Consequently, the core temperature can rise quickly to injurious levels.
Forms of Heat Illness
Heat Stress
Before heat stroke occurs, lesser degrees of dysfunction …
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