Early diagnosis of heat exhaustion and heat stroke is of vital importance as these conditions may progress to fatal complications.
In most cases diagnosis is made clinically. This involves taking the temperature and assessing the symptoms of heat exhaustion and heat stroke.
Steps to diagnosis of the condition include assessment of core body temperature, blood tests and so forth. (1-4)
Usually heat exhaustion may manifest as sweaty and clammy extremities and heat stroke may manifest as hot or warm limbs. The actual body temperature needs to be measured at the core.
Usually the thermometer is placed within the mouth, in the groin folds or armpits to detect the core temperature. A temperature of 40°C (104°F) or above is often a major sign of heatstroke.
Heatstroke however can be diagnosed at lower temperatures and these temperatures are not always indicative of heat stroke as they may be reached by athletes during physical exercise.
A routine blood test is done. This detects other problems like anemia, diabetes and presence of infections.
The blood electrolytes like Sodium, Potassium and bicarbonates are disturbed in heat related health conditions. These are assessed on blood tests.
Liver and kidney function tests are prescribed to check for damage. Blood levels of urate indicates kidney health and levels of creatine kinase detects muscle breakdown or rhabdomyolysis.
Other tests performed to diagnose heat stroke include:
Other conditions that must be ruled out in diagnosis as they mimic heat stroke include:
There may be a history of intake of antipsychotics leading to side effects like neuroleptic malignant syndrome or antidepressants leading to serotonin syndrome. Both manifest with features like heat stroke.
Heat stroke like features is also seen in drug abusers who use amphetamine, cocaine, ecstasy etc.
Those with heat exhaustion and heat stroke need the following therapy approaches:
Alcohol and caffeine containing drinks are avoided as they lead to further dehydration. In patients with heat exhaustion the symptoms decrease in an hour or so and leave no long term effects.
They may be immersed in cool but not cold water. This last step is best performed under medical supervision as the boy may respond with a sudden change in blood pressure especially among those who have heart disease or the elderly.
For vomiting and unconscious patients, position on their side is preferable to avoid choking. In these emergency department must be immediately notified.
Cooling is slowed or stopped once the temperature is <38.5ºC, to avoid overcooling. Iced gastric lavage and peritoneal lavage is attempted in severe cases.