Heat Stroke Diagnosis and Management.

1. Heat Stroke
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2. Occurs with high core temperature  direct thermal
tissue injury
2ndary effect: acute renal failure from
rhabdomyolysis

3. 1. Classic Heat Stroke
Occurs after several days of heat exposure
Individual at risk:
1. Chronically ill
2. Dehydrated
3. Elderly
4. Obese
5. With Chronic CardioVascular Disease
6. Alcohol abuse
7. Those who use sedative, hypnotics, a-adrenergic
antagonist, diuretics, cholinergics, or antipsychotics

4. Classic Heat Stroke
Risk factors:
1. High humidity
2. Lack of air-conditioning
> 50% have infection
Have core temp > 40.5 C
Usually comatose and anhidrotic

5. 2. Exertional Heat Stroke
Occurs rapidly in unacclaimatized & unfit person who
exrcised in high ambient temperature & humidity
At risk: (if they lack access to water)
Athletes
Soldiers
Laborers
Congenital diseases that impair sweating may
contribute
Core temp may < 40.5 C

6. DIAGNOSIS:
1. Hx of exposure and exercise
2. Core temp 40 C or more
3. Changes in mental status (confusion  delirium 
coma)

7. DDX:
1. Malignant hyperthermia
2. Neuroleptic Malignant Syndrome
3. Anticholinergic Poisoning
4. Sympathomimetic Toxicity (inc. Cocaine)
5. Severe Hyperthyroidism
6. Sepsis
7. Meningitis
8. Cerebral Malaria
9. Encephalitis
10. Hypothalamic Dysfunction due to hemorrhage or stroke
11. Brain Abscess

8. Treatment:
Immediate Cooling with Ice Application and Tepid
Spray
If severely elevated core temp  Gastric lavage with
ice water
Monitor core temp continuously by rectal probe
Discontinue cooling measures when the core temp
reaches 39 C ideally achieved within 30 minutes
A temperature rebound may occur in 3-6 hours and
should be retreated
Hypotension: crystalloid  or vassopressors

9. Monitoring
Cbc, PT, PTT, Fibrin degradation
Products, electrolytes, BUN, Creatinine, Glucose, Ca, C
K, Liver Function test, ABG, U/A, ECG

10. Complications
Rhabdomyolysis or urine output of less than 30ml/min
1. Adequate fluid replacement
2. Mannitol-12.5 to 25 grams IV
3. Bicarbonate 44 -100 meq/L
To promote osmotic diuresis and urine alkalinization
Hypoxemia and ARDS
Seizures