Emergency Medicine Book

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Heat Exhaustion

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  1. See Also
    1. Heat Illness
  2. Mechanisms
    1. Dehydration
    2. Electrolyte loss
    3. Exercise-induced Respiratory Alkalosis
  3. Symptoms
    1. Fatigue
    2. Weakness
    3. Nausea and Vomiting
    4. Dizziness
    5. Myalgias
    6. Irritability
    7. Headache
    8. Dyspnea
  4. Signs
    1. Temperature increased between 100.4 (38) to 104 (40)
    2. Hypotension or Orthostasis
    3. Syncope
    4. Sweating
    5. Cutaneous Flushing
    6. Decreased urine output
    7. Mild neurologic changes
      1. Incoordination
      2. Confusion
      3. Irritability
      4. Mental status not seriously impaired
        1. Contrast with Heat Stroke
  5. Labs
    1. Normal Liver Function Tests (contrast with Heat Stroke)
      1. AST Normal
      2. ALT Normal
      3. LDH Normal
    2. Monitoring with fluid Resuscitation
      1. Serum Sodium
      2. Serum Potassium
      3. Serum phosphate
      4. Serum Calcium
      5. Serum Magnesium
  6. Management
    1. External cooling
      1. Cool environment
      2. Remove excess clothing
      3. Spray lukewarm water on body
      4. Cool with fans
    2. Gradual rehydration
      1. Manage Hypernatremia or Hyponatremia if present
      2. Oral Rehydration (Mild cases)
        1. 1 Liter per hour over several hours
      3. Intravenous Rehydration
        1. Initial isotonic fluid replacement (NS or LR)
        2. Replace 50% total water deficit in first 3-6 hours
        3. Replace remaining 50% deficit over 6-9 hours
  7. Prevention
    1. See Heat Illness Prevention
  8. References
    1. Czerkawski (1996) Your Patient Fitness 10(4): 13-20
    2. Sandor (1997) Physician SportsMed, 25(6):35-40
    3. Barrow (1998) Am Fam Physician 58(3):749
    4. Hett (1998) Postgrad Med 103(6):107
    5. Wexler (2002) Am Fam Physician 65(11):2307

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