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Heat stroke

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Heat stroke is a life-threatening medical emergency caused by a failure in the body's thermoregulation. Thermoregulation is the process the body uses to maintain a stable internal temperature. When external heat or physical exertion overwhelms these cooling mechanisms, the core body temperature can rise above 40 degrees Celsius. This extreme hyperthermia, or abnormally high body temperature, can cause multi-organ dysfunction. It can lead to serious complications like seizures, kidney failure, or rhabdomyolysis. Rhabdomyolysis occurs when skeletal muscle breaks down and releases products into the bloodstream, which can harm organs.

There are two distinct types of heat stroke: classic and exertional. Classic heatstroke, or non-exertional heatstroke (NEHS), typically affects elderly or infirm individuals during hot summer months. It often occurs due to high environmental temperatures and insufficient ventilation. In classic cases, the skin is usually dry because the body is not sweating. Exertional heatstroke (EHS) is more common in young, healthy people like athletes, military personnel, or outdoor laborers. This type is caused by strenuous physical activity in the heat. Unlike classic cases, people with EHS often have wet or sweaty skin.

The biological mechanism of heat stroke involves a complex physiological breakdown. As the body overheats, it can disrupt enzymes that regulate biochemical reactions. These reactions are essential for cellular respiration and the function of major organs. One theory involves a process called endotoxemia. Extreme heat and exercise may disrupt the intestinal barrier, making it more permeable. This allows lipopolysaccharides (LPS), which are from bacteria in the gut, to enter the circulatory system. High levels of LPS can trigger a systemic inflammatory response. This can lead to sepsis, blood coagulation issues, and central nervous system dysfunction.

Diagnosing heat stroke is a clinical process based on a constellation of symptoms. Doctors look for a high core temperature, usually above 40 degrees Celsius, alongside neurological dysfunction. Neurological signs include disorientation, confusion, delirium, agitation, or slurred speech. Other symptoms include dizziness, nausea, vomiting, and even combativeness. Because oral or skin temperatures can be inaccurate, doctors prefer measuring rectal temperature to monitor the core. Other clinical findings might include tachycardia, which is a rapid heart rate, or hypotension, which is low blood pressure.

Certain groups face much higher risks due to biological or environmental factors. Children are particularly vulnerable because of their physiology. They have an increased surface area to mass ratio, which leads to higher environmental heat absorption. They also have an underdeveloped thermoregulatory system and a decreased sweating rate. Elderly adults are also at high risk, especially during heat waves. Environmental factors like humidity also play a role. High humidity reduces the body's ability to cool itself through perspiration and evaporation.

Data shows that heat stroke is a significant public health issue. In the United States, more than 600 deaths occur from heat stroke annually. Research shows that these rates increased between 1995 and 2015. Heat stroke is also a major danger in vehicles. If the outside temperature is 30 degrees Celsius, the inside of a parked car can quickly exceed 40 degrees Celsius. In 2018, 51 children in the United States died from being left in hot cars. This was a higher number than the 49 deaths recorded in 2010.

Treatment must focus on rapid physical cooling to prevent death or permanent damage. The goal is to lower the body temperature to below 39 degrees Celsius, ideally below 38.5 degrees Celsius. One of the most effective methods is ice-water immersion, which is considered the gold standard for exertional heat stroke. Another method is evaporative cooling, which involves spraying the person with water while using a fan. In hospitals, doctors may also use cold intravenous fluids. While ice packs can help, they do not achieve the fastest cooling on their own. Prompt treatment is vital to reverse organ dysfunction and save lives.

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