HEAT EXHAUSTION Treatment Tips
Heat exhaustion is the most common form of heat illness. There are two distinct types of heat exhaustion:
(i) Water Depletion Heat Exhaustion, or dehydration
(ii) Salt Depletion Heat Exhaustion.
Water-depletion heat exhaustion and salt-depletion heat exhaustion are caused, respectively, by the inadequate replacement of water and salt lost from prolonged sweating. These two types of heat exhaustion can occur in pure form, but more commonly, elements of both water and salt depletion are present.
WATER DEPLETION HEAT EXHAUSTION (WDHE)
Water-depletion heat exhaustion occurs when the body's water supply is limited or no water is available. Water-depletion heat exhaustion is similar to extremes of thirst encountered by those who are shipwrecked or adrift for weeks. Larger quantities of water, relative to salt, are lost in the urine and sweat. The first symptom is thirst, which may become extreme; fatigue, weakness, anxiety, impaired judgment, and dulling of the mental faculties follow. Later, there may be increased rates of breathing, tingling of the extremities, restlessness, disorientation and hysteria. The final stages are delirium, coma, and death. Weight loss always occurs and increases as the water deficit increases.
The time sequence depends on the environmental temperature and the amount of energy expended by the victim. Death may not occur for seven to ten days in temperate climates, but may occur within twelve hours if one is marching across a hot desert without water.24 Marriott has divided water depletion exhaustion cases into three clinical grades. Judged according to weight loss, water deficit, and symptoms, such cases are said to be in the early stages if weight loss is 2 percent and thirst is the only symptom. Weight loss of 4 to 6 percent is moderately severe, as is a water deficit of 4.2 liters (for a 70 kilogram person); accompanying symptoms include high pulse rate, dry mouth, and low urine output. Very severe cases show weight loss above 7 percent and the marked impairment of both mental and physical capacity.
Treatment for WATER DEPLETION HEAT EXHAUSTION (WDHE)
Water-depletion heat exhaustion is a result of water restriction, whether voluntary or involuntary. Treatment is aimed at restoration of body water. Total water deficit can be estimated by changes in body weight, since rapid weight loss is almost entirely fluids.
Prevention Tips for WATER DEPLETION HEAT EXHAUSTION (WDHE)
The sensation of thirst should make prevention easy. Daily water requirements according to weight or maintenance of a daily urine volume of 850 ml (approx. one quart) will forestall the development of dehydration.
SALT DEPLETION HEAT EXHAUSTION (SDHE)
Salt-depletion heat exhaustion is due to the inadequate replacement of salt lost in sweating. It occurs especially in unacclimatized men who drink water freely without salt replacement. An individual who normally has a generous quantity of salt in his diet may lose large quantities of salt in his sweat. Salt losses in sweat begin to decrease within one day and do so for three or four days. The response of the kidneys, which is to conserve salt, begins immediately and reaches a maximum in three to four days.
The most frequent symptoms of salt-depletion heat exhaustion are fatigue, giddiness, nausea, constipation, vomiting, anorexia (loss of appetite), muscle cramps, and headache, in that order. Fatigue is almost always present and may be extreme. Anorexia, nausea, and vomiting will contribute to the severity of salt depletion. The victim feels better when lying down; this also relieves the headache and giddiness. Muscle cramps occur in about 2/3 of cases and are similar to those of heat cramps.
Salt-depletion heat exhaustion develops insidiously and progresses over several days. The victim looks haggard and has pallid, clammy and inelastic skin. The pulse is weak and fast and the blood pressure may be low. On standing suddenly, the pulse rate increases very rapidly, the blood pressure falls, and the victim feels dizzy and may faint. The body temperature is usually normal. Marked dehydration and weight loss do not occur, so that the volume of urine and sweat remain normal.
Exhaustion due to salt depletion has again been graded clinically by Marriott. In a 154-pound man, a salt deficit of 35 grams accompanied by giddiness and fatigue define the early stage of the illness. Greater deficits up to 55 grams, with concomitant nausea and cramps, mark the progression to a moderately severe case. Still greater salt losses, and a drop in blood pressure with possible shock, delineate very severe salt depletion.
The differentiation of water-depletion heat exhaustion from salt-depletion heat exhaustion is aided by the fact that the pure forms tend to exclude each other. One type usually predominates, but seldom in pure form.
Salt-depletion heat exhaustion with muscle cramps can be distinguished from heat cramps in two ways. First, systemic symptoms are not associated with heat cramps. Also, salt-depletion heat exhaustion most commonly affects unacclimatized individuals, while heat cramps usually involve well-acclimatized individuals in good physical condition. (There is some disagreement in the literature on this point.) At any rate, the presence and degree of systemic symptoms will quickly identify muscle cramps associated with salt-depletion heat exhaustion as opposed to "heat cramps."
Treatment for SALT DEPLETION HEAT EXHAUSTION (SDHE)
Victims of salt-depletion heat exhaustion should be put in bed in a cool room and given cool, salted drinks. Large quantities of unsalted fluids may produce muscle cramps.
Prevention Tips for SALT DEPLETION HEAT EXHAUSTION (SDHE)
(i) Water Depletion Heat Exhaustion, or dehydration
(ii) Salt Depletion Heat Exhaustion.
Water-depletion heat exhaustion and salt-depletion heat exhaustion are caused, respectively, by the inadequate replacement of water and salt lost from prolonged sweating. These two types of heat exhaustion can occur in pure form, but more commonly, elements of both water and salt depletion are present.
WATER DEPLETION HEAT EXHAUSTION (WDHE)
Water-depletion heat exhaustion occurs when the body's water supply is limited or no water is available. Water-depletion heat exhaustion is similar to extremes of thirst encountered by those who are shipwrecked or adrift for weeks. Larger quantities of water, relative to salt, are lost in the urine and sweat. The first symptom is thirst, which may become extreme; fatigue, weakness, anxiety, impaired judgment, and dulling of the mental faculties follow. Later, there may be increased rates of breathing, tingling of the extremities, restlessness, disorientation and hysteria. The final stages are delirium, coma, and death. Weight loss always occurs and increases as the water deficit increases.
The time sequence depends on the environmental temperature and the amount of energy expended by the victim. Death may not occur for seven to ten days in temperate climates, but may occur within twelve hours if one is marching across a hot desert without water.24 Marriott has divided water depletion exhaustion cases into three clinical grades. Judged according to weight loss, water deficit, and symptoms, such cases are said to be in the early stages if weight loss is 2 percent and thirst is the only symptom. Weight loss of 4 to 6 percent is moderately severe, as is a water deficit of 4.2 liters (for a 70 kilogram person); accompanying symptoms include high pulse rate, dry mouth, and low urine output. Very severe cases show weight loss above 7 percent and the marked impairment of both mental and physical capacity.
Treatment for WATER DEPLETION HEAT EXHAUSTION (WDHE)
Water-depletion heat exhaustion is a result of water restriction, whether voluntary or involuntary. Treatment is aimed at restoration of body water. Total water deficit can be estimated by changes in body weight, since rapid weight loss is almost entirely fluids.
Prevention Tips for WATER DEPLETION HEAT EXHAUSTION (WDHE)
The sensation of thirst should make prevention easy. Daily water requirements according to weight or maintenance of a daily urine volume of 850 ml (approx. one quart) will forestall the development of dehydration.
SALT DEPLETION HEAT EXHAUSTION (SDHE)
Salt-depletion heat exhaustion is due to the inadequate replacement of salt lost in sweating. It occurs especially in unacclimatized men who drink water freely without salt replacement. An individual who normally has a generous quantity of salt in his diet may lose large quantities of salt in his sweat. Salt losses in sweat begin to decrease within one day and do so for three or four days. The response of the kidneys, which is to conserve salt, begins immediately and reaches a maximum in three to four days.
The most frequent symptoms of salt-depletion heat exhaustion are fatigue, giddiness, nausea, constipation, vomiting, anorexia (loss of appetite), muscle cramps, and headache, in that order. Fatigue is almost always present and may be extreme. Anorexia, nausea, and vomiting will contribute to the severity of salt depletion. The victim feels better when lying down; this also relieves the headache and giddiness. Muscle cramps occur in about 2/3 of cases and are similar to those of heat cramps.
Salt-depletion heat exhaustion develops insidiously and progresses over several days. The victim looks haggard and has pallid, clammy and inelastic skin. The pulse is weak and fast and the blood pressure may be low. On standing suddenly, the pulse rate increases very rapidly, the blood pressure falls, and the victim feels dizzy and may faint. The body temperature is usually normal. Marked dehydration and weight loss do not occur, so that the volume of urine and sweat remain normal.
Exhaustion due to salt depletion has again been graded clinically by Marriott. In a 154-pound man, a salt deficit of 35 grams accompanied by giddiness and fatigue define the early stage of the illness. Greater deficits up to 55 grams, with concomitant nausea and cramps, mark the progression to a moderately severe case. Still greater salt losses, and a drop in blood pressure with possible shock, delineate very severe salt depletion.
The differentiation of water-depletion heat exhaustion from salt-depletion heat exhaustion is aided by the fact that the pure forms tend to exclude each other. One type usually predominates, but seldom in pure form.
Salt-depletion heat exhaustion with muscle cramps can be distinguished from heat cramps in two ways. First, systemic symptoms are not associated with heat cramps. Also, salt-depletion heat exhaustion most commonly affects unacclimatized individuals, while heat cramps usually involve well-acclimatized individuals in good physical condition. (There is some disagreement in the literature on this point.) At any rate, the presence and degree of systemic symptoms will quickly identify muscle cramps associated with salt-depletion heat exhaustion as opposed to "heat cramps."
Treatment for SALT DEPLETION HEAT EXHAUSTION (SDHE)
Victims of salt-depletion heat exhaustion should be put in bed in a cool room and given cool, salted drinks. Large quantities of unsalted fluids may produce muscle cramps.
Prevention Tips for SALT DEPLETION HEAT EXHAUSTION (SDHE)
The prevention of salt-depletion heat exhaustion requires the maintenance of adequate levels of salt. The degree of acclimatization is a crucial factor in determining precise needs for extra salt. Such salt supplements need not be taken if water intake is adequate, and fully acclimatized individuals won't normally require salt supplements.
However, unacclimatized people who are exercising in warm environments for significant periods always require salt supplements. A daily intake of twenty grams of salt should be the goal if there is prolonged exertion in the heat, and this intake is approximately twice the quantity consumed in an average diet. Heavier salting of food normally provides an adequate supplement. Such supplements can be slowly reduced after seven to ten days as acclimatization takes place, but they should be maintained if overall food intake drops or diarrhea occurs.
However, unacclimatized people who are exercising in warm environments for significant periods always require salt supplements. A daily intake of twenty grams of salt should be the goal if there is prolonged exertion in the heat, and this intake is approximately twice the quantity consumed in an average diet. Heavier salting of food normally provides an adequate supplement. Such supplements can be slowly reduced after seven to ten days as acclimatization takes place, but they should be maintained if overall food intake drops or diarrhea occurs.
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