Heat Exhaustion
GENERAL PRINCIPLES
Heat exhaustion often results from a combination of water and sodium depletion. Water depletion is the result of either overwhelming losses, such as profuse sweating or vomiting, or inadequate replacement.
Persons at risk include the elderly, patients taking diuretics, and those working in hot environments with limited water replacement. Salt depletion occurs in unacclimatized individuals who replace fluid losses with large amounts of hypotonic solution.DIAGNOSIS
• The patient presents with headache, nausea, vomiting, dizziness, weakness, irritability, and/or cramps.
• The patient may have postural hypotension, diaphoresis, and normal or minimally increased core temperature.
TREATMENT
• Treatment consists of removing excess or restrictive clothing, resting the patient in a cool environment, accelerating heat loss by fan evaporation, and using salt-containing solutions for fluid repletion.
• If the patient is not vomiting and has stable blood pressure, an oral, commercial, balanced salt solution
is adequate.
• If the patient is vomiting or hemodynamically unstable, check electrolytes and give 1-2 L of 0.9% isotonic crystalloid IV
• The patient should avoid exertion in a hot environment for 2-3 additional days.