Managing Exertional Heat Stroke Among the Combatants

• Main Authors: Santosh Kumar Singh, Sarvinder Singh, Bhaskar Shahbabu, Ajai T Kumar, Vani Singh
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2017-12-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: delirium; exercise; hot temperature; military personnel; seizures
• Online Access: https://jcdr.net/articles/PDF/10926/28015-CE(RA1)_F(GG)_PF1(BT_PT_SS_PFA_MJ_AnG).pdf

Exertional Heat Stroke (EHS) is a medical emergency which when not addressed timely can lead to high mortality and morbidity. Armed forces are vulnerable to heat stroke because of their involvement in strenuous physical exercises in extremes of climatic conditions. The present case series aimed to analyse the clinical features, complications and effect of prompt treatment on the final outcome of the patients. Soldiers reporting with heat related cases were screened to identify those suffering from EHS and various relevant information was collected. It was found that 33.3% of patients were not acclimatised to the environment before taking part in strenuous physical activities and had deranged liver and renal function. Most (77.8%) of the patients had run 5 km just before having EHS. All patients had delirium on presentation and 16.7% had seizures. Majority (77.8%) of the patients had normal blood pressure on presentations. All patients developed diarrhea whereas liver enzymes were raised in 11.1%, 33.3% had renal failure and 11.1% developed multiorgan failure. On aggressive management with rapid cooling, intravenous fluids and other supportive medications, all patients of EHS recovered completely without any mortality and were discharged from the hospital within one week of admission, without any residual neurological deficit except two patients who developed multiorgan failure requiring haemodialysis for six weeks. Despite taking innumerable precautionary measures, EHS cannot be entirely prevented but continuous monitoring and aggressive management can lead to a great reduction in morbidity and mortality of the patients.