[5 cases of occupational heat illness].

Objective: Through the analysis of five cases of occupational heat illness caused by high temperature, we expounded the pathogenesis and summarized the clinical characteristics of heat cramp and heat exhaustion of the newly revised diagnostic criteria for occupational heat illness (GBZ41-2019), in order to prevent the occurrence of occupational heat illness to put forward controllable countermeasures. Methods: According to the occupational history, clinical diagnosis and treatment and the other relevant data submitted by five patients, the diagnosis process was analyzed and summarized. Results: Five patients developed symptoms from July to August in summer, belonging to high-temperature operation. They improved by timely treatment. The symptoms, signs and laboratory tests of the five patients were different, but they were diagnosed as occupational heat illness. Conclusion: Employers should pay attention to the high temperature protection and cooling work, and strengthen the labor protection. If patients with heat cramp and heat exhaustion were timely treated, they could basically recover. Occupational disease diagnosticians should seriously study the new diagnostic criteria of occupational disease and constantly improve their diagnostic ability.

Heat exhaustion.

Heat exhaustion is part of a spectrum of heat-related illnesses that can affect all individuals, although children, older adults, and those with chronic disease are particularly vulnerable due to their impaired ability to dissipate heat. If left uninterrupted, there can be progression of symptoms to heatstroke, a life-threatening emergency. Signs and symptoms of heat exhaustion may develop suddenly or over time. Exposure to a hot environment for a prolonged period and performing exercise or work in the heat can overwhelm the body's ability to cool itself, causing heat exhaustion. Heat exhaustion can be worsened by dehydration due to inadequate access to water or insufficient fluid replacement. Heat exhaustion can be managed by the immediate reduction of heat gain by discontinuing exercise and reducing radiative heat source exposure. The individual should be encouraged to drink cool fluids and remove or loosen clothing to facilitate heat loss. In more extreme situations, more aggressive cooling strategies (e.g., cold shower, application of wet towels) to lower core temperature should be employed. Heat-related illnesses such as heat exhaustion can be prevented by increasing public awareness of the risks associated with exposure to high temperatures and prolonged exercise.

Collapse in the Heat - From Overhydration to the Emergency Room - Three Cases of Exercise-Associated Hyponatremia Associated with Exertional Heat Illness.

Exertional heat illness and exercise-associated hyponatremia continue to be a problem in military and recreational events. Symptoms of hyponatremia can be mistaken for heat exhaustion or heat stroke. We describe three cases of symptomatic hyponatremia initially contributed to heat illnesses. The first soldier was a 31-yr-old female who "took a knee" at mile 6 of a 12-mile foot march. She had a core temperature of 100.9°F, a serum sodium level of 129 mmol/L, and drank approximately 4.5 quarts of water in 2 h. The second case was a 27-yr-old female soldier who collapsed at mile 11 of a 12-mile march. Her core temperature was 102.9°F and sodium level was 131 mmol/L. She drank 5 quarts in 2.5 h. The third soldier was a 27-yr-old male who developed nausea and vomiting while conducting an outdoor training event. His core temperature was 98.7°F and sodium level was 125 mmol/L. He drank 6 quarts in 2 h to combat symptoms of heat. All the three cases developed symptomatic hyponatremia by overconsumption of fluids during events lasting less than 3 h. Obtaining point-of-care serum sodium may improve recognition of hyponatremia and guide management for the patient with suspected heat illness and hyponatremia. Depending on severity of symptoms, exercise-associated hyponatremia can be managed by fluid restriction, oral hypertonic broth, or with intravenous 3% saline. Utilizing an ad libitum approach or limiting fluid availability during field or recreational events of up to 3 h may prevent symptomatic hyponatremia while limiting significant dehydration.

A mimic of sexually-motivated homicide: insect stings and heat exhaustion in a forest.

We report the case a woman who was found dead in a forest. The body was nude and the position of the body suggested a sexually motivated homicide. We concluded that death was not related to homicide, but was related to the conjunction of environmental factors, including insect stings, and acute psychosis. A medicolegal death investigation with postmortem examination was undertaken to determine cause of death. At the scene, the body was supine with legs spread apart and the knees flexed, exposing the external genitalia. There were multiple apparent bruises on the body and neck. At autopsy, based on macroscopic and microscopic examination, the apparent bruises were found to be hemorrhagic insect bites. No significant injuries were present and no semen was found. Death appeared to be related to heat exhaustion and innumerable insect stings. Investigation of the medical history revealed longstanding schizoaffective disorder with episodic psychotic decompensations. In the past, during an acute psychotic episode the decedent removed her clothing and ran wildly in a forest, until she was rescued in a state of exhaustion and marked agitation, and taken to hospital for treatment. We concluded that the same circumstances had been repeated but with a fatal outcome. This case is an example of a mimic of sexually-motivated homicide and is a reminder to forensic pathologists to avoid tunnel vision. We need to be skeptical of the allure of common sense based on first impressions of the scene and the body. Forensic pathologists must be unafraid to scientifically explore improbable, but true, alternate explanations.

Clinical Impact of Speed Variability to Identify Ultramarathon Runners at Risk for Acute Kidney Injury.

BACKGROUND: Ultramarathon is a high endurance exercise associated with a wide range of exercise-related problems, such as acute kidney injury (AKI). Early recognition of individuals at risk of AKI during ultramarathon event is critical for implementing preventative strategies. OBJECTIVES: To investigate the impact of speed variability to identify the exercise-related acute kidney injury anticipatively in ultramarathon event. METHODS: This is a prospective, observational study using data from a 100 km ultramarathon in Taipei, Taiwan. The distance of entire ultramarathon race was divided into 10 splits. The mean and variability of speed, which was determined by the coefficient of variation (CV) in each 10 km-split (25 laps of 400 m oval track) were calculated for enrolled runners. Baseline characteristics and biochemical data were collected completely 1 week before, immediately post-race, and one day after race. The main outcome was the development of AKI, defined as Stage II or III according to the Acute Kidney Injury Network (AKIN) criteria. Multivariate analysis was performed to determine the independent association between variables and AKI development. RESULTS: 26 ultramarathon runners were analyzed in the study. The overall incidence of AKI (in all Stages) was 84.6% (22 in 26 runners). Among these 22 runners, 18 runners were determined as Stage I, 4 runners (15.4%) were determined as Stage II, and none was in Stage III. The covariates of BMI (25.22 ± 2.02 vs. 22.55 ± 1.96, p = 0.02), uric acid (6.88 ± 1.47 vs. 5.62 ± 0.86, p = 0.024), and CV of speed in specific 10-km splits (from secondary 10 km-split (10th - 20th km-split) to 60th - 70th km-split) were significantly different between runners with or without AKI (Stage II) in univariate analysis and showed discrimination ability in ROC curve. In the following multivariate analysis, only CV of speed in 40th - 50th km-split continued to show a significant association to the development of AKI (Stage II) (p = 0.032). CONCLUSIONS: The development of exercise-related AKI was not infrequent in the ultramarathon runners. Because not all runners can routinely receive laboratory studies after race, variability of running speed (CV of speed) may offer a timely and efficient tool to identify AKI early during the competition, and used as a surrogate screening tool, at-risk runners can be identified and enrolled into prevention trials, such as adequate fluid management and avoidance of further NSAID use.

Mechanisms by Which Dehydration May Lead to Chronic Kidney Disease.

Dehydration, a condition that characterizes excessive loss of body water, is well known to be associated with acute renal dysfunction; however, it has largely been considered reversible and to be associated with no long-term effects on the kidney. Recently, an epidemic of chronic kidney disease has emerged in Central America in which the major risk factor seems to be recurrent heat-associated dehydration. This has led to studies investigating whether recurrent dehydration may lead to permanent kidney damage. Three major potential mechanisms have been identified, including the effects of vasopressin on the kidney, the activation of the aldose reductase-fructokinase pathway, and the effects of chronic hyperuricemia. The discovery of these pathways has also led to the recognition that mild dehydration may be a risk factor in progression of all types of chronic kidney diseases. Furthermore, there is some evidence that increasing hydration, particularly with water, may actually prevent CKD. Thus, a whole new area of investigation is developing that focuses on the role of water and osmolarity and their influence on kidney function and health.

Rhabdomyolysis and acute renal failure in a sickle cell trait athlete: a case study.

This case study reports the clinical details and pathologic mechanisms of a nonfatal case of rhabdomyolysis secondary to heat exhaustion and sickle cell trait (SCT) resulting in acute renal failure. A 19-year-old African American male college football player collapsed after running 5 intervals of 300 m during a preseason conditioning test. After 17 days of treatment, the athlete was released from the hospital to a short-term noncritical care facility for further treatment and dialysis. Scientific literature reports that at least 15 college football players with SCT have died as a result of a sickling crisis after intense physical exertion. This case study presents the clinical importance of prompt medical treatment and sustained low-efficiency dialysis in treating rhabdomyolysis and its sequelae after collapse in an SCT athlete.

Efecto del calor sobre el número de urgencias hospitalarias en la región de Murcia durante los veranos del período 2000-2005 y su uso en la vigilancia epidemiológica / Effect of weather temperature on hospital emergencies in the region of Murcia, Spain, throught the 2000-2005 and its use in epidemiological surveillance

Fundamento: el efecto de las temperaturas sobre la mortalidad ha sido estudiado más en profundidad que el efecto sobre la morbilidad. En Murcia se monitorizan el número de urgencias diarias y los casos de golpes de calor atendidos en los hospitales de la Región. Objetivo: valorar el efecto de la temperatura sobre el número de urgencias hospitalarias y la utilidad de estos indicadores para vigilar la morbilidad por calor. Métodos: se ha estudiado el efecto de la temperatura sobre el número de urgencias en verano (periodo 2000-2005), estimando el incremento porcentual de urgencias cuando se superan los umbrales establecidos por el Ministerio de Sanidad y Consumo (Tª máxima 38ºC y Tª mínima 22,4ºC) y por cada grado de aumento de temperatura, expresado en Riesgo Relativo (RR) con un IC95%. Se han cotejado los golpes de calor comunicados con los ingresos registrados en el Conjunto Mínimo Básico de Datos al Alta Hospitalaria (CMBD). Resultados: En 2000-2005 las urgencias se incrementaron un 1,6% en los días con más de 22,4ºC de mínima (RR 1,016; IC95% 1,0076-1,0244), y un 0,21% por cada grado de aumento de la mínima (RR 1,0021; IC95% 1,0000-1,0044). El 38% de los golpes de calor ingresados no se notificaron, y el 40% de los notificados tenían exposición laboral. Conclusiones: La temperatura mínima podría tener un mayor efecto en Murcia que la máxima. Con los actuales umbrales, el número de urgencias diarias no parece un indicador adecuado para monitorizar el efecto de la temperatura, necesitándose información sobre el diagnóstico y la edad. Los golpes de calor aportan información parcial del impacto, pero resaltan grupos de población en riesgo menos considerados (AU)

Background: The effect of the weather temperature on mortality has been studied more in depth than its effect on morbidity. In Murcia, the number of daily emergencies and the cases of heat stroke for which care is provided at the hospitals in this Region have been studied. Objective: to evaluate the effect that the weather temperature has on the number of hospital emergencies and the use of these indicators for the surveillance of hot weather-related morbidity. Methods: The effect of the weather temperature on the number of summertime emergencies (2000-2005) has been studied by estimating the percentage increase in emergencies when the weather temperature thresholds established by the Ministry of Health and Consumer Affairs (Max. 38ºC and Min. 22.4ºC) are exceeded, and by each degree of temperature rise. Results have been stated as Relative Risk (RR) with a 95% CI. A comparison has been drawn between the heat strokes notified and the hospital admissions recorded in the Minimum Basic Data Set at Hospital Discharge (MBDS). Results: Within the 2000-2005 period, the number of emergencies rose by 1.6% on those days when the minimum temperature for the day was above 22.4ªC (RR: 1.016; 95%CI 1.0076 - 1.0244) and by 0.21% for each degree of rise in the minimum temperature for the day (RR: 1.0021, 95% CI 1.0000-1.0044). A total of 38% of the heat strokes admitted to hospital were not reported, of which 40% had occupational exposure. Conclusions: The minimum temperature for the day could have a greater effect in Murcia than the maximum for the day. Based on the current thresholds, the number of emergencies/day does not seem to be a suitable indicator for monitoring the effect of the weather temperature, information on the diagnosis and the age being needed. Heat strokes provide partial information on the impact, but highlight less-considered population groups at risk (AU)

Thermoregulatory influence of a cooling vest on hyperthermic athletes.

CONTEXT: Athletic trainers must have sound evidence for the best practices in treating and preventing heat-related emergencies and potentially catastrophic events. OBJECTIVE: To examine the effectiveness of a superficial cooling vest on core body temperature (T(c)) and skin temperature (T(sk)) in hypohydrated hyperthermic male participants. DESIGN: A randomized control design with 2 experimental groups. SETTING: Participants exercised by completing the heat-stress trial in a hot, humid environment (ambient temperature = 33.1 +/- 3.1 degrees C, relative humidity = 55.1 +/- 8.9%, wind speed = 2.1 +/- 1.1 km/hr) until a T(c) of 38.7 +/- 0.3 degrees C and a body mass loss of 3.27 +/- 0.1% were achieved. PATIENTS OR OTHER PARTICIPANTS: Ten healthy males (age = 25.6 +/- 1.6 years, mass = 80.3 +/- 13.7 kg). INTERVENTION(S): Recovery in a thermoneutral environment wearing a cooling vest or without wearing a cooling vest until T(c) returned to baseline. MAIN OUTCOME MEASURE(S): Rectal T(c), arm T(sk), time to return to baseline T(c), and cooling rate. RESULTS: During the heat-stress trial, T(c) significantly increased (3.6%) and, at 30 minutes of recovery, T(c) had decreased significantly (2.6%) for both groups. Although not significant, the time for return to baseline T(c) was 22.6% faster for the vest group (43.8 +/- 15.1 minutes) than for the no-vest group (56.6 +/- 18.0 minutes), and the cooling rate for the vest group (0.0298 +/- 0.0072 degrees C/min) was not significantly different from the cooling rate for the no-vest group (0.0280 +/- 0.0074 degrees C/min). The T(sk) during recovery was significantly higher (2.1%) in the vest group than in the no-vest group and was significantly lower (7.1%) at 30 minutes than at 0 minutes for both groups. CONCLUSIONS: We do not recommend using the cooling vest to rapidly reduce elevated T(c). Ice-water immersion should remain the standard of care for rapidly cooling severely hyperthermic individuals.

Pattern and determinants of hospitalization during heat waves: an ecologic study.

BACKGROUND: Numerous studies have investigated mortality during a heatwave, while few have quantified heat associated morbidity. Our aim was to investigate the relationship between hospital admissions and intensity, duration and timing of heatwave across the summer months. METHODS: The study area (Veneto Region, Italy) holds 4577408 inhabitants (on January 1st, 2003), and is subdivided in seven provinces with 60 hospitals and about 20000 beds for acute care. Five consecutive heatwaves (three or more consecutive days with Humidex above 40 degrees C) occurred during summer 2002 and 2003 in the region. From the regional computerized archive of hospital discharge records, we extracted the daily count of hospital admissions for people aged >or=75, from June 1 through August 31 in 2002 and 2003. Among people aged over 74 years, daily hospital admissions for disorders of fluid and electrolyte balance, acute renal failure, and heat stroke (grouped in a single nosologic entity, heat diseases, HD), respiratory diseases (RD), circulatory diseases (CD), and a reference category chosen a priori (fractures of the femur, FF) were independently analyzed by Generalized Estimating Equations. RESULTS: Heatwave duration, not intensity, increased the risk of hospital admissions for HD and RD by, respectively, 16% (p < .0001) and 5% (p < .0001) with each additional day of heatwave duration. At least four consecutive hot humid days were required to observe a major increase in hospital admissions, the excesses being more than twofold for HD (p < .0001) and about 50% for RD (p < .0001). Hospital admissions for HD peaked equally at the first heatwave (early June) and last heatwave (August) in 2004 as did RD. No correlation was found for FF or CD admissions. CONCLUSION: The first four days of an heatwave had only minor effects, thus supporting heat health systems where alerts are based on duration of hot humid days. Although the finding is based on a single late summer heatwave, adaptations to extreme temperature in late summer seem to be unlikely.

Exertional heat stroke in competitive athletes.

Exertional heat stroke (EHS) is a serious medical condition that can have a tragic outcome if proper assessment and treatment are not initiated rapidly. This article focuses on critical misconceptions that pertain to the prevention, recognition, and treatment of EHS, including 1) the randomness of EHS cases, 2) the role of nutritional supplements in EHS, 3) temperature assessment, 4) onset of EHS and the possible lucid interval, 5) rapid cooling, and 6) return to play. Exploration of these topics will enhance the medical care regarding EHS.

Fracaso hepático agudo tras golpe de calor / Acute liver failure following heat stroke

La afectación hepática en el curso de un golpe de calor suele ser un proceso frecuente, necesitando en algunos casos muy graves y raros de la realización de trasplante hepático. Presentamos el caso de un paciente varón de 31 años, deportista amateur, que mientras participaba en una competición de maratón sufrió un golpe de calor con fracaso hepático agudo acompañado de rabdomiolisis, insuficiencia renal y coagulopatía. La elevada temperatura ambiental, la duración del ejercicio y la altura a la que se realizó pudieron contribuir a la aparición del cuadro. La evolución del paciente, tras la aplicación de medidas conservadoras, fue favorable recibiendo el alta hospitalaria en pocos días

Hepatic involvement during heat stroke appears frequently. In some severe and rare cases liver transplantation is needed. We report a case of a 31 years old man, amateur runner, who suffered heat stroke-related acute liver failure, rhabdomyolysis, renal failure and coagulation im-pairment during a marathon. High environmental temperature, exercise duration and height where race took place could be involved. Patient had a favourable course with conservative treatment being discharged in a few days