The dangers of heatstroke: how to stop overheating

The dangers of heatstroke and how to keep your cool throughout the summer months.

Heatstroke symptoms, causes and treatment
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It's forecast to be an Indian summer and us Brits are notoriously unprepared for soaring temperatures, so heat related-illnesses are likely to be on the increase. Soaking in the summer sun is one of life's great pleasures – but you can have too much of a good thing and if left unchecked heatstroke can have serious health consequences.

Travel Medicine, Mental and Occupational Health specialist Dr Charlie Easmon looks at the heatstroke warning signs and explains how to keep your cool as the mercury rises:

What is heatstroke?

Heatstroke is a condition in which the brain's normal heat regulation system fails and the body becomes overheated in a relatively short space of time.

This can be a life-threatening condition, requiring urgent medical attention. Some soldiers on training have died from this condition.



What causes heatstroke?

Abnormally high body temperatures (hyperthermia) may occur in several different circumstances, including the following:

• Classic heatstroke

Also called sunstroke, which us a little misleading because the condition can arise without the direct effect of the sun, this is when, typically, the skin is flushed, red and dry.

• Heatstroke caused by exertion

This often occurs in conjunction with pronounced physical exertion, eg sports activity.

• Extensive burns

Including sunburn, this is where the sweat glands have been damaged or destroyed.

• Less common medical conditions

A number of less common medical conditions, such as over activity of the thyroid gland (thyrotoxicosis).



Heatstroke symptoms

Heatstroke occurs when the body cannot dispose of excess heat in the normal way. Heatstroke and fever can be distinguished as follows:

Fever: in which the body's mechanism for regulating temperature is functioning and set at a higher level. The patient is, typically, flushed and bathed in sweat.

Primary hyperthermia: for instance, heatstroke, where temperature regulation is either partially or totally out of action. The patient often sweats only a little or not at all, and the skin is flushed red, hot and dry.



When does heatstroke become critical?

There are a number of factors which may indicate heatstroke is critical. If you are concerned, seek urgent medical assistance;

  • Body temperature around 41°C (this can be measured in the rectum).
  • You feel increasingly unwell, tired and dizzy, and your head may hurt and you may feel 'distant'.
  • You may feel cold, despite the heat and this is a very worrying symptom.
  • If your skin becomes flushed red and dry (ie perspiration is reduced or not functioning).
  • You produce less urine, which is of a dark yellowish colour (which indicates a shortage of fluid).
  • You become less alert, with a tendency to faint, and experience confusion, impairment or loss of consciousness and convulsions.
  • At temperatures above 41°C the situation starts to be serious. At temperatures above 42°C cell damage to the brain, liver, kidneys and skeletal muscle often occurs as well as bleeding disorders.


    What puts you at risk of heatstroke?

    There are a number or heatstroke risks, particularly when travelling in hot climates:

    • Surroundings with high temperature, high humidity and strong sunlight (typically in the tropics).
    • Too much physical exertion (eg sport), particularly in the above conditions.
    • Extensive sunburn, particularly in a hot and humid climate.
    • Lack of fluids or salt in hot and particularly tropical surroundings.
    • Excessive alcohol consumption under the same conditions
    • Inappropriate non-breathing clothing. The loose non-synthetic, clothing of locals has a purpose.
    • Lack of shelter from the sun.


      Heatstroke prevention tips

      There are a number of measures you can take to avoid heatstroke in hot climates:

      ✔️ It's important to get used to heat and humidity slowly, particularly before physical exertion. This acclimatisation to the tropics can typically take one to three weeks.

      ✔️ Make sure you drink plenty of sugar and salt liquids (at least 3 to 5 litres a day, but not alcohol). In very hot conditions you may need to drink much more and a good tip is to start the day by drinking at least two litres!

      ✔️ Military and extreme sports specialists should consider testing their sodium excretion since this can vary eightfold and hence there is an eightfold variation in how much sodium needs to be replaced.

      ✔️ Wear light, airy, loose-fitting clothing, such as light cotton.

      ✔️ Be careful if you undertake any hard physical exertion, particularly if your fluid/salt intake is low.

      ✔️ Stay in the shade or, if possible, in an air-conditioned environment.

      ✔️ Take frequent dips in cool water (in the sea or pool), particularly if you are sunbathing.

      ✔️ Monitor the colour of your urine. The lighter the better, as this equals adequate
      hydration.



      Heatstroke treatment tips

      If a person suffers from heatstroke, if possible, the patient should be taken to a doctor, or better still a hospital, as soon as possible. A person with heatstroke often needs oxygen, a drip (fluid infusion into a vein) and sometimes medication. In the interim, try the following tips:

      • Get out of the sun

      It's important to put them in the shade and preferably in a cool environment - ideally an air-conditioned room at a temperature of 15 to 18°C.

      • Remove clothes

      The patient should be undressed, with sensitivity, or covered only by a thin sheet.

      • Cool down using water

      If the patient's temperature rises to 39.5°C and the skin is still dry and burning hot (or with only very slight sweating), they should be showered with cool water (15 to 18°C). You can also put the person in a bath of cool water, while massaging the skin to increase circulation.

      • Bring their temperature down

      Another possibility is to cover the patient with wet sheets or towelling, changing them often, preferably in combination with an electric fan, or something similar, to bring the temperature further down.

      ⚠️ Do not use water cooler than 15°C because this will restrict heat loss because the blood vessels in the skin will contract.

      Who is particularly at risk of heatstroke?

      If you or someone close to you falls into any of the below categories, take extra precautions in hot weather to avoid heatstroke:

      • Elderly and often weak or fragile people with a low fluid level.
      • People who are overweight.
      • People with cardiovascular or lung diseases.
      • People taking certain types of medication, such as anticholinergics (which prevent sweat production) and beta-blockers (which reduce the blood circulation to the skin).
      • Infants and small children.
      • Some people taking recreational drugs, such as ecstasy.
      • Pregnant women (particularly if their fluid or salt levels are low).
      • People under the influence of alcohol.
      • People who play a lot of sport without taking sensible precautions, such as drinking plenty of appropriate rehydration fluids or who wear non-breathing clothes inappropriate to the activity.


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