This summer has been hot, especially these last few weeks. With heat comes heat-related illness, a group of illnesses that are typically caused by exposure to high heat and the body overworking to cool itself down. These conditions range from heat rash, which is uncomfortable but harmless, to heat stroke, which is life-threatening and requires immediate hospitalization. Reece Moose, PA-C, of Catawba Valley Family Medicine – Conover and Kristin Gottry, NP-C, of Catawba Valley Family Medicine – Northeast Hickory are here to discuss heat-related illnesses and how you can prevent and treat them.
You may have an increased risk for heat related illness if you:
o Work outdoors in hot temperatures, especially with high humidity
o Exercise or do athletic competitions in a hot environment
o Do intense physical activity in the heat without slowly building up to it
o Exert yourself in the heat while wearing heavy equipment or protective gear
o Are over age 65 and do strenuous physical activity in the heat
o Are paralyzed, or have ever had a TBI
o Have certain medical conditions, like hyperhidrosis (excessive sweating), Multiple Sclerosis, Parkinson’s, and thyroid disorders, just to name a few
o Take medications that make temperature regulation more difficult, like antidepressants, antihistamines, and beta blockers, just to name a few
The most common and least dangerous of these heat-related illnesses is heat rash. Heat rash is very common in the summer due to sweating, but fortunately, it usually gets better on its own after a few days. Heat rash occurs when sweat glands get blocked, and the trapped sweat leads to a rash developing a few days later. Babies often get heat rash because they cannot control their temperature as well as adults and children can. The rash looks red on white skin, but it may be harder to see or look grey or white on brown or black skin. It can appear anywhere on the body and spread; however, it cannot be passed on to other people.
The symptoms of heat rash are:
o small, raised spots
o an itchy, prickly feeling
o mild swelling
If you have a heat rash, the main thing to do is keep your skin cool so you do not sweat and irritate the rash. To keep your skin cool, wear loose cotton clothing, use lightweight bedding, take cool baths or showers, and drink plenty of fluid to avoid dehydration. To calm the itching or prickly feeling, apply something cold, such as a damp cloth or ice pack wrapped in a towel, for up to 20 minutes. Also, tap or pat the rash instead of scratching it and avoid using perfumed shower gels or creams. You can also speak to a pharmacist about heat rash, and they can give advice and suggest the best treatment to use. A pharmacist might recommend calamine lotion, antihistamine tablets, and/or hydrocortisone cream (not for children under 10, unless directed by your doctor).
A more serious condition related to prolonged heat exposure is heat cramps, also called exercise-associated muscle cramps. These are muscle cramps in your legs, arms, belly or elsewhere. They typically occur when you’re exerting yourself in the heat and sweating a lot. When you sweat a lot, your body loses salt and nutrients (electrolytes) in the sweat. Drinking large amounts of water quickly helps hydrate you, but it also dilutes the nutrients in your body. That can cause your muscles to tighten and cramp.
When you experience heat cramps, you may feel an uncomfortable tightening of the muscles in your:
o Abdomen (belly)
o Arms
o Hands
o Feet
o Legs
o Rib cage
o Shoulders
Heat cramps are a mild form of heat-related illness, and you’ll usually have a normal or slightly elevated body temperature, but these cramps are a warning that more severe illness could occur if you don’t take steps to cool down. Heat cramps are usually the first sign of heat exhaustion, which can progress into heat stroke. Heat cramps can turn into heat exhaustion or heatstroke if you remain in a hot environment and don’t replenish your lost electrolytes. Heat cramps are a sign that your body is overheated, so cool down and stay hydrated to avoid more serious heat-related illnesses.
Reece adds, “Overall, it is important to be in tune with yourself and listen to what your body is telling you. If you feel like you are becoming too hot or start to develop cramps in your legs, stop what you are doing and return to a cool air-conditioned environment and begin oral rehydration to avoid progression to the later stages of heat illness.”
Heat exhaustion is even more concerning than heat cramps. Heat exhaustion is a moderate form of heat illness that can quickly turn into heat stroke without treatment. Your internal body temperature is elevated but is still below 104 degrees Fahrenheit. It happens when you lose too much water and/or electrolytes, typically when exerting yourself in the heat. When you’re sweating a lot, it can be hard to take in enough fluids and electrolytes to replenish what you’re losing. With heat exhaustion, you’re aware of what’s going on and don’t have any persistent disruptions to your brain function. You might feel momentarily confused, but this feeling soon passes. Persistent confusion or changes to your mental state could signal heat stroke.
Symptoms of heat exhaustion include:
o Heavy sweating
o Cold, clammy skin
o Muscle cramps
o Headache
o Dizziness
o Feeling tired or weak
o Feeling thirsty
o Nausea or vomiting
o Muscle cramping (heat cramps)
o Fast heart rate/tachycardia
o Fast and weak pulse (“thready” pulse)
o Fast, deep breathing or hyperventilating
o Elevated body temperature, typically between 101 to 104 degrees Fahrenheit
Heat exhaustion treatment involves cooling your body, hydrating and monitoring for signs of heat stroke. Treatment often begins on-site, wherever heat exhaustion happens — this is because the faster you cool your body down, the better your chances of preventing a progression to heat stroke. But you should still call emergency services so a healthcare provider can check you and provide further care at a hospital, if needed.
If you have signs or symptoms of heat exhaustion, do these things right away:
o Call for medical help. Avoid being alone while waiting for help to arrive in case your exhaustion progresses into heat stroke.
o Immediately move to a cooler or shaded area.
o Loosen or remove excess clothes and lie down with your legs elevated.
o Use any available means to cool your body — like fanning yourself or soaking towels in ice water and applying them to your skin.
o Slowly sip water or other fluids. But do NOT drink anything if you suspect you might have heat stroke, as people with heat stroke are at risk of inhaling fluids.
To prevent heat exhaustion, stay hydrated, limit physical activity in the heat, dress for hot weather, and let your body adjust to higher than usual temperatures. Reece also notes that parents should monitor their children to make sure they are staying hydrated in high temperatures, as they may not understand the role hydrating plays in their overall health.
Heat stroke is the most severe form of heat-related illness. Heat stroke causes your body temperature to soar to dangerous levels, typically above 104 degrees Fahrenheit. Without intervention, heat exhaustion can quickly develop into heat stroke. But heat stroke can also develop without warning. Heat exhaustion and heat stroke share similar symptoms — like dizziness, nausea and weakness, but a key difference is that heat stroke causes brain dysfunction. This means you experience changes to your thinking and behavior — like confusion, agitation and aggression. You may also pass out. Heat stroke is life-threatening and requires immediate medical treatment. Serious complications can occur with heat stroke including coma, rhabdomyolysis (muscle breaking down into toxins), reduced flow of blood and oxygen to your organs, and severe damage to major organs like your lungs, kidneys, heart, or liver.
The signs and symptoms of heat stroke include:
o High internal (core) body temperature, typically over 104 degrees Fahrenheit (40 degrees Celsius)
o Behavior changes — like agitation or aggression
o Blurred vision
o Confusion
o Delirium
o Dizziness
o Fainting (syncope)
o Fast heart rate (tachycardia)
o Fast, shallow breathing (tachypnea)
o Low blood pressure (hypotension)
o Nausea and vomiting
o Seizures
o Slurred speech
o Skin color changes — either flushed or paler than usual
o Skin that is either dry or very sweaty
o Weakness
If you notice someone suffering from heat stroke, move the person out of the sun or heat to a cooler spot. Call 911 and ensure medical help is on the way. Help cool them down by pouring cool water over their skin, using anything available to fan them, and applying ice or cold packs to their armpits or neck. It’s also just as important to know what NOT to do. Don’t give the person fever-reducing medication, like acetaminophen. These medications don’t help heat stroke, which happens for different reasons than a fever, and they may also worsen complications like organ damage. Also, don’t give them any fluids to drink. A person experiencing heat stroke might accidentally inhale the liquid, which can be dangerous.
Someone suffering from heat stroke will need to be transported to the nearest hospital or medical center. Healthcare providers in the emergency room focus on cooling your body until it gets to a safe temperature. Common methods for cooling include:
o Cold water immersion. This is usually used for heat stroke caused by overexertion rather than classic heat stroke. A provider dunks your entire body (except your head) in cold water or ice water. Heat leaves your body and enters the surrounding water.
o Misting and fanning. This is often used for classic heat stroke but can be suitable for either type. A provider sprays as much of your skin as possible with water while large fans circulate the air around you. As the water evaporates from your skin, your body temperature lowers.
Providers will also closely monitor you for signs of complications and give you further treatment as needed. This might include IV fluids, intubation, and/or medications to support organ function. You’ll need to stay in the hospital — possibly the intensive care unit — until providers determine it’s safe for you to go home. Some people have lingering effects for weeks or months after having heat stroke, including trouble coordinating muscle movements, slurred speech or trouble speaking so others can understand, and trouble forming new memories (anterograde amnesia).
To prevent heat-related illnesses, stay hydrated, limit physical activity in the heat, dress for hot weather, and let your body adjust to higher than usual temperatures. Kristin recommends a goal of at least 64 ounces of water per day to remain hydrated, with an increase in water consumption during exercise or strenuous activity. She also advises to dress for hot weather, including wearing light-colored, loose-fitting, and breathable clothing and wearing sun protection including hats, as well as applying (and reapplying) sunscreen and remaining indoors when the temperature outside is at its hottest time of the day.
Kristin says, “In the clinic, we have seen an increase in the number of patients experiencing mild heat-related illnesses over the last couple of weeks, including dizziness, weakness and fatigue, and mildly elevated temperatures. Most of the time, these episodes are preventable if you are proactive and implement the above safety recommendations while spending time outdoors!”
