Tragic! A mother passed away from heat stroke as she selflessly gave the fan to her child on a hot summer day!

According to a recent news report in Zhejiang, China, a woman in her thirties suffered from severe heat stroke. On a scorching day, she didn't turn on the air conditioner at home and gave the fan to her child. By the time her family realized she wasn’t well enough and took her to the hospital, she had already fallen into a deep coma. Despite of all doctors' efforts, nothing the doctors could do to help.

The weather is heating up, and as the temperature rises, so does the risk of heat stroke. We aren't talking about simply feeling hot, or uncomfortable, or sweating excessively. Heat stroke is life threatening emergency!

01. What is Heat Stroke?

Heat stroke, also known as severe heat exhaustion, is a life-threatening clinical syndrome caused by an imbalance between heat production and heat dissipation in the body due to exposure to a hot environment or intense physical activity. It is characterized by a core temperature higher than 40°C, along with symptoms such as burning sensation of skin, altered mental status (such as delirium, seizures, or coma), and multi-organ system injury.

Heat stroke can be divided into classic heat stroke (CHS) and exertional heat stroke(EHS).It is categorized as classic when it results from passive exposure to extreme environmental heat and as exertional when it develops during strenuous exercise. Exertional heatstroke affects predominantly young and healthy individuals.

02. Epidemiological Characteristics of Heat Stroke

Of all extreme weather conditions, heat is the most deadly. It kills more people in the U.S. in an average year than hurricanes, tornadoes and floods combined. According to data from abroad, the incidence of classic heat stroke during the summer heatwave is (17.6~26.5) per 100,000 population, with a hospital mortality rate of 14%~65% and an ICU patient mortality rate of >60%. Patients with exertional heat stroke accounted for 8.6%~18% of those with heat-related illnesses, and the mortality rate is >30% when combined with hypotension. Additionally, classic heat stroke has a higher mortality rate, which may be related to underlying pre-existing diseases.

03. Prevention Measures for Heat Stroke

04. Diagnostic Methods of Heat Stroke

 Medical history information:

① Exposure to high temperature and high humidity environment;
② High-intensity exercise.

Clinical Features:

① Central nervous system dysfunction (such as coma, seizures, delirium, abnormal behavior, etc.);
② Increased skin temperature or sustained sweating with core temperature exceeding 40℃;
③ Multiorgan (≥2) dysfunction (liver, kidney, skeletal muscle, gastrointestinal, etc.), with manifestations such as significantly elevation in liver transaminases, muscle weakness, muscle pain and tawny urine;
④ Significant decrease in platelets, severe coagulation dysfunction or DIC.
⑤ CK value 5 times higher than the normal value.

Differential diagnosis:

Here are some possible conditions that share the same symptoms such as central nervous system diseases, infectious diseases, metabolic disorders, water and electrolyte balance disorders, malignant hyperthermia.We should do as follows to differentiate them.

Laboratory examination:

Improve blood urine and stool routine, organ function evaluation indicators, coagulation function markers, inflammatory markers, infection markers, electrolytes, myocardial injury markers, rhabdomyolysis markers, arterial blood gas indicators and other tests as soon as possible, and perform blood culture if necessary.
As shown in Table 1.

The Getein's Chemiluminescence Immunoassay Analyzer, MAGICL 6000 is capable of rapidly detecting cardiovascular and inflammatory markers. It is a powerful tool providing rapid diagnosis for patients with heat stroke！

Reference

[1] ：刘树元, 宋景春, 毛汉丁, & 赵金宝. (2019). 中国热射病诊断与治疗专家共识. 解放军医学杂志, 44(3), 16.
[2]  Liu S, Song J, Mao H et al., Consensus of Chinese experts on the diagnosis and treatment of heat stroke. Med J Chin PLA, Vol. 44, No. 3, 2019