Rarely, severe heat exhaustion after hard work may be complicated by rhabdomyolysis Rhabdomyolysis Rhabdomyolysis is a clinical syndrome involving the breakdown of skeletal muscle tissue. Symptoms and signs include muscle weakness, myalgias, and reddish-brown urine, although this triad is... read more , myoglobinuria, and acute kidney injury Acute Kidney Injury (AKI) Acute kidney injury is a rapid decrease in renal function over days to weeks, causing an accumulation of nitrogenous products in the blood (azotemia) with or without reduction in amount of urine... read more . It is distinguished from heatstroke Heatstroke Heatstroke is hyperthermia accompanied by a systemic inflammatory response causing multiple organ dysfunction that may result in death. Symptoms include temperature > 40° C and altered mental... read more by the absence of brain dysfunction (eg, confusion, ataxia).
(See also Overview of Heat Illness Overview of Heat Illness Heat illness encompasses a number of disorders ranging in severity from muscle cramps and heat exhaustion to heatstroke (which can be a life-threatening emergency). Current estimates of heat-related... read more .)
Symptoms and Signs of Heat Exhaustion
Symptoms of heat exhaustion are often vague, and patients may not realize that heat is the cause. Symptoms may include malaise, weakness, dizziness, headache, nausea, and sometimes vomiting. Syncope due to standing for long periods in the heat (heat syncope) may occur. On examination, patients appear tired, are usually sweaty and tachycardic, and may have orthostatic hypotension. Mental status is intact, unlike in heatstroke. Temperature is usually normal and, when elevated, usually does not exceed 40° C.
Diagnosis of Heat Exhaustion
Diagnosis of heat exhaustion is clinical and requires exclusion of other possible causes of a patient's symptoms (eg, hypoglycemia, acute coronary syndrome, various infections). Laboratory testing is required only if needed to rule out such disorders. Electrolyte levels should be measured to exclude severe hyponatremia in patients who have had excessive free water intake.
Treatment of Heat Exhaustion
Oral or IV fluid and electrolyte replacement
Treatment of heat exhaustion involves stopping all exertion and removing patients to a cool environment, having them lie flat, and attempting oral rehydration with a solution of 0.1% sodium chloride. Patients should drink about 1 L/hour. If vomiting or nausea prevents oral rehydration, IV fluid and electrolyte replacement therapy, typically using 0.9% saline solution, is indicated. Also, if symptoms do not resolve after 30 to 60 minutes of oral rehydration, patients should be transported to an emergency department, where rehydration is usually done IV. Rate and volume of IV rehydration are guided by age, underlying disorders, and clinical response. Replacement of 1 to 2 L at 500 mL/hour is often adequate. Older patients and patients with heart disorders may require lower rates. External cooling measures (see Heatstroke: Treatment Treatment Heatstroke is hyperthermia accompanied by a systemic inflammatory response causing multiple organ dysfunction that may result in death. Symptoms include temperature > 40° C and altered mental... read more ) are usually not required. However, if patients with heat exhaustion have a core temperature of ≥ 40° C, measures may be taken to reduce it.
In heat exhaustion, symptoms tend to be nonspecific, temperature is usually < 40° C, and CNS function is not impaired.
Diagnose heat exhaustion clinically, testing as indicated to exclude other clinically suspected disorders.
Have patients rest in a cool environment and try oral rehydration, transporting patients to an emergency department if these measures are unsuccessful.
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