{
 "topic": "Heat Exhaustion",
 "slug": "heat-exhaustion",
 "category_id": 15909,
 "passage_count": 14,
 "source_chars": 12164,
 "enough_material": true,
 "references": [
  {
   "title": "Cover",
   "author": "Vitalsource Download",
   "pages": [
    1779,
    1783
   ]
  },
  {
   "title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "author": null,
   "pages": []
  },
  {
   "title": "Pediatric Environmental Health",
   "author": "American Academy of Pediatrics Council on Environmental Health,Ruth A. Etzel,Sophie J. Balk",
   "pages": [
    485,
    486
   ]
  },
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    4362
   ]
  },
  {
   "title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition",
   "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.",
   "pages": [
    359
   ]
  },
  {
   "title": "Pediatric Clinical Practice Guidelines and Policies",
   "author": "American Academy of Pediatrics (AAP);",
   "pages": [
    1264
   ]
  },
  {
   "title": "MedStudy Pediatrics Core 11th Edition 2024-2025",
   "author": null,
   "pages": [
    315
   ]
  },
  {
   "title": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition",
   "author": "American Academy of Pediatrics",
   "pages": [
    1238
   ]
  }
 ],
 "passages": [
  {
   "source": "Cover, p. 1783",
   "text": "of a child\u2019s reach. Secondary prevention is crucial to prevent progression. A child exhibiting nausea, vomiting, headache, dizziness, or mental status change after heat exposure should be removed from the activity, rehydrated, and immediately evaluated for potential heat exhaustion or heatstroke by a healthcare professional trained in the assessment of this condition, so that active measures can be instituted to prevent further complications of heat exhaustion and heatstroke. ## **NONENVIRONMENTAL HYPERTHERMIA** ## **Malignant Hyperthermia** _Malignant hyperthermia_ (MH) is an autosomal-dominant disorder with an estimated prevalence of 1:3000. The principal defect is a mutation in the gene for the skeletal muscle ryanodine receptor ( _RyR1_ ), which is a calcium channel found in the sarcoplasmic reticulum. Malignant hyperthermia is a rare event and is most commonly triggered by the use of volatile inhalation anesthetic agents or the muscle-depolarizing agent succinylcholine."
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "evaporation. The spectrum of illness is broad, including heat cramps, heat exhaustion, and heat stroke. Heat stroke is an acute medical emergency with significant associated morbidity and mortality. Children with increased risk include those with cystic fibrosis or congenital absence of sweat glands, children receiving medications that cause oligohidrosis, those with eating disorders, diabetes insipidus, obesity, or uncontrolled diabetes mellitus, infants left in automobiles on hot days, and young athletes."
  },
  {
   "source": "Pediatric Environmental Health, p. 486",
   "text": "Chapter 26: Cold and Heat 469 ## **Types of Heat Injury** Injuries resulting from heat extremes include heat exhaustion, heat cramps, and heat stroke. These often occur in a continuum when early signs of heat injury are not addressed.22 Heat exhaustion typically results from the combination of sustained heat and dehydration. Children can develop faintness, extreme tiredness, and headache; there may be fever and intense thirst.22 Other signs and symptoms include nausea, vomiting, hyperventilation, and paresthesias. Heat exhaustion is treated with rest, fluids, and hydration with electrolyte-containing drinks."
  },
  {
   "source": "Cover, p. 1779",
   "text": "## **PATHOPHYSIOLOGY** In hyperthermia, the body temperature is elevated above normal because the heat-dissipating homeostatic mechanisms activated at temperatures above the set point are overwhelmed. Contrary to earlier thinking, children do not have less effective thermoregulatory ability, insufficient cardiovascular capacity, or lower physical exertion tolerance compared to adults when they exercise in the heat and maintain adequate hydration. The main modifiable risk factors for exertional heat-illness risk related to sports and other physical activities in a hot environment include poor hydration status, undue physical exertion, lack of time to recover from repeated exercise bouts, closely scheduled same-day training or sports competition, and clothes, uniforms, and protective equipment that do not allow heat dissipation. ## **CLASSIFICATION**"
  },
  {
   "source": "Pediatric Environmental Health, p. 485",
   "text": "Heat extremes can produce several health effects in children, the most common of which is dehydration, while the most severe include rhabdomyolysis, exercise-associated collapse, and death. Dehydration occurs from the combination of insensible water losses through exhaled air and sweating. Children generally sweat at a rate of 1 L/hour/m2. In unacclimatized adolescents, 1 to 4 L of fluid can be lost in a single hour of exertion, accompanied by the loss of several grams of salt. When the body is no longer able to compensate for temperature extremes, the core temperature rises and produces pyrexia (fever). Core body temperatures of 100\u00b0F to 106\u00b0F (37.8\u00b0C\u201341.1\u00b0C) can lead to sweating, tachycardia, and disorientation. Body temperatures greater than 106\u00b0F (41.1\u00b0C) are associated with agitation, seizures, tachycardia, ventricular irritability, and metabolic acidosis. Body temperatures greater than 110\u00b0F (43.3\u00b0C) can quickly lead to cardiovascular collapse. Chapter 26: Cold and Heat 469"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 4362",
   "text": "Chapter 731 **Heat Injuries** _Gregory L. Landry and Andrew M. Watson_ **Heat illness** is among the leading causes of death in U.S. high school athletes. It is a continuum of clinical signs and symptoms that can be mild (heat stress) to fatal (heat stroke). Children are more vulnerable to heat illness than adults because they have a greater ratio of surface area to body mass and produce greater heat per kilogram of body weight during activity. The sweat rate is lower in children, and the temperature at which sweating occurs is higher. Although there is considerable interindividual variability, children can take longer to acclimatize to warmer, more humid environments (typically 8-12 near- consecutive days of 30- to 45- minute exposures). Children also have a blunted thirst response compared with adults and might not consume enough fluid during exercise in hot, humid environments to prevent dehydration. In addition, certain medications may predispose to heat- related injury (Table 731.1)."
  },
  {
   "source": "Pediatric Environmental Health, p. 486",
   "text": "Heat stroke, the most extreme form of heat-related illness, is an emergency that occurs independently of hydration. Heat stroke occurs with a core body temperature (via rectal temperature shortly after collapse) of greater than 104\u00b0F to 105\u00b0F (40\u00b0C\u201340.5\u00b0C), along with signs of central nervous system dysfunction.19 It is typically categorized as exertional and nonexertional. Exertional heat stroke tends to occur in athletes, soldiers, and laborers; it remains one of the most common causes of death and disability among US high school athletes, with more than 9,000 illnesses per year.1,19,22,23 Nonexertional heat stroke occurs in the absence of physical activity. In children, nonexertional heat stroke is most often the result of being left unattended in vehicles because the temperature inside a car rapidly rises above the ambient temperature.22,24 In children with heat stroke, stupor or coma, tachycardia, hypertension, or hypotension develop. Severe rhabdomyolysis can occur, resulting in myoglobinuria and acute"
  },
  {
   "source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 359",
   "text": "6. Admit to the pediatric intensive care unit. ## \u00bb **Prognosis** Full recovery is the rule for heat cramps and heat exhaustion. Patients with heat stroke are at risk of end-organ damage due to volume depletion, rhabdomyolysis, direct renal injury, hepatocellular injury, and DIC; however, even in this critically ill population, some children recover fully with intensive management. ## **HYPOTHERMIA** ESSENTIALS OF DIAGNOSIS & TYPICAL FEATURES - \u00bb Hypothermia is defined as a core temperature of less than 35\u00b0C. - \u00bb Children are at increased risk due to a greater BSAweight ratio. **327** **EMERGENCIES & INJURIES** - \u00bb In children, hypothermia is most commonly associated with water submersion. ## \u00bb **Prevention** Given the high association with submersion injuries, children should be carefully monitored around water. Proper use of life vests is critical. ## \u00bb **Clinical Findings** ## **A. Signs and Symptoms**"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 4362",
   "text": "**Heat exhaustion** is a moderate illness with a core temperature of 37.7\u201340\u00b0C (100\u2013104\u00b0F). It is manifested as weakness, fatigue, headache, nausea, vomiting, dizziness, orthostasis, piloerection, and possibly syncope. Central nervous system dysfunction is mild, if present. Treatment includes moving to a cool environment, cooling the body with fans, removing excess clothing, and placing ice over the groin and axillae. If a patient is not able to tolerate oral rehydration, IV fluids are indicated. Patients should be monitored, including rectal temperature, for signs of heat stroke. If rapid improvement is not achieved, transport to an emergency facility is recommended."
  },
  {
   "source": "Pediatric Environmental Health, p. 485",
   "text": "Other risk factors for heat-associated illness in children include chronic diseases (eg, diabetes mellitus, obesity, cystic fibrosis), medications (eg, anticholinergics, stimulant medications, opioids, phenothiazines), and reduced ability to seek protection or communicate needs (infants and children with physical disabilities). A current or recent illness, particularly gastroenteritis, may produce residual effects of fluid loss. Sickle cell trait also increases the risk of complications associated with strenuous exercise in the heat.3"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Heat exhaustion may also occur because of predominant salt depletion. As in heat cramps, water losses are replaced but without adequate electrolyte supplementation. Symptoms include profound weakness and fatigue, frontal headache, anorexia, nausea, vomiting, diarrhea, and severe muscle cramps. Tachycardia and orthostatic hypotension may be noted. Hyponatremia, hemoconcentration, and significantly diminished urine sodium are consistent findings. Children with cystic fibrosis, particularly those who are young and unable to meet increased salt requirements, are at risk for electrolyte depletion because salt losses in their sweat apparently do not respond to acclimatization and aldosterone stimulation of the sweat gland. Heat stroke is a life-threatening emergency. Classic signs are hyperpyrexia (41\u00b0C [105.8\u00b0F] or higher); hot, dry skin that is pink or ashen (anhidrosis) depending on the circulatory state; and severe CNS dysfunction. Often sweating ceases before the onset of heat stroke."
  },
  {
   "source": "Pediatric Clinical Practice Guidelines and Policies, p. 1264",
   "text": "**POLICY TITLES AND ABSTRACTS** **1245** wearing clothing, uniforms, and protective equipment that play a role in excessive heat retention. Because these known contributing risk factors are modifiable, exertional heat illness is usually preventable. With appropriate preparation, modifications, and monitoring, most healthy children and adolescents can safely participate in outdoor sports and other physical activities through a wide range of challenging warm to hot climatic conditions. (8/11, reaffirmed 2/15) **http://pediatrics.aappublications.org/content/128/3/e741** ## **CLINICAL CONSIDERATIONS RELATED TO THE BEHAVIORAL MANIFESTATIONS OF CHILD MALTREATMENT (CLINICAL REPORT)** - _Robert D. Sege, MD, PhD, FAAP; Lisa Amaya-Jackson, MD, MPH, FAACAP; Committee on Child Abuse and Neglect; and Council on Foster Care, Adoption, and Kinship Care (joint with American Academy of Child and Adolescent Psychiatry Committee on Child Maltreatment and Violence and National Center for Child Traumatic Stress)_"
  },
  {
   "source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 315",
   "text": "[Figure OCR, page 315, figure 1] medications (e.g., stimulants). Prevention includes heat acclimatization, staying well hydrated, replenishing salt with sports drinks, and limiting the amount of outdoor activity. Heat cramps are muscle cramps occurring during exer- cise and are the mildest form of heat illness. Treat with rest, hydration, salt replenishment, and stretching of the affected muscle. Heat exhaustion refers to the inability of the body to main- tain a normal temperature during exercise and presents with tachycardia, profuse sweating, and weakness. The body temperature is between 38.9\u00b0C and 40.0\u00b0C (102.0\u00b0F and 104,0\u00b0F), and there are no significant CNS symptoms. Treatment consists of stopping the activity, moving to a cool place, removing any unnecessary clothing or equip- ment, drinking fluids, and taking an ice-water bath or using ice packs. Monitor temperature during the cooling process; discontinue monitoring when the temperature falls to < 38.9\u00b0C (102.0\u00b0F) or shivering occurs."
  },
  {
   "source": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition, p. 1238",
   "text": "ABSTRACT. Results of new research indicate that, contrary to previous thinking, youth do not have less effective thermoregulatory ability, insufficient cardiovascular capacity, or lower physical exertion tolerance compared with adults during exercise in the heat when adequate hydration is maintained. Accordingly, besides poor hydration status, the primary determinants of reduced performance and exertional heat-illness risk in youth during sports and other physical activities in a hot environment include undue physical exertion, insufficient recovery between repeated exercise bouts or closely scheduled same-day training sessions or rounds of sports competition, and inappropriately wearing clothing, uniforms, and protective equipment that play a role in excessive heat retention. Because these known contributing risk factors are modifiable, exertional heat illness is usually preventable. With appropriate preparation, modifications, and monitoring, most healthy children and adolescents can safely participate in"
  }
 ]
}