De-Hydration and Heat Stroke

[hoot72]

Hi

Any words of wisdom from experinced medics in dealing with heat stroke and de-hydration in a tropical jungle environment with high humidity levels in the upper 90;s and ground temperature's in access of 34+ celcius?

Has anyone resorted to using IV and salt-rehydration tablets?

[SouthernDZ]

It’s a problem and is one reason SFAS doesn’t run during the height of summer.

The best fluid to drink when you are sweating is water. I haven’t seen salt tablets used since the 80s; taking salt tablets may raise the body's sodium level to hazardous levels. Although there is some salt in perspiration, you don't really lose that much with your sweat, except in special (usually pathological) circumstances. As prevention is always the best method, have your guys eat their salt, sugar and cocoa packet with every meal and wash down with a quart of water (cocoa has potassium). Putting any kind of sport drink in the canteen or camelback is a bad idea. Things will grow in the sugar residue, especially in the jungle. Nalgene bottles work pretty well; have them flip a couple of spoonfuls in their mouths occasionally. Gatorade is the most reasonable price; make certain to cut it first. Remember, significant hyponatremia can result from voluntary overhydration and can be dangerous.

As for heat stroke, just remember that hyponatremia and significant dehydration are not always associated. Heat stroke usually results from total hypothalamic failure; the body can’t regulate, the temperature rises rapidly, the sweating system fails and the body cannot cool down. Cool them down, but go easy on the fluids with these casualties.

It’s a jungle out there.

[sfbaby1982]

Hey what are your thoughts on the oral re hydration salts that they so freely issued during the Q? I don't think that they are the salt tablets that you mentioned and if I remember correctly they are pasted on Potassium salt.

R

[hoot72]

Originally Posted by SouthernDZ

It’s a problem and is one reason SFAS doesn’t run during the height of summer.

The best fluid to drink when you are sweating is water. I haven’t seen salt tablets used since the 80s; taking salt tablets may raise the body's sodium level to hazardous levels. Although there is some salt in perspiration, you don't really lose that much with your sweat, except in special (usually pathological) circumstances. As prevention is always the best method, have your guys eat their salt, sugar and cocoa packet with every meal and wash down with a quart of water (cocoa has potassium). Putting any kind of sport drink in the canteen or camelback is a bad idea. Things will grow in the sugar residue, especially in the jungle. Nalgene bottles work pretty well; have them flip a couple of spoonfuls in their mouths occasionally. Gatorade is the most reasonable price; make certain to cut it first. Remember, significant hyponatremia can result from voluntary overhydration and can be dangerous.

As for heat stroke, just remember that hyponatremia and significant dehydration are not always associated. Heat stroke usually results from total hypothalamic failure; the body can’t regulate, the temperature rises rapidly, the sweating system fails and the body cannot cool down. Cool them down, but go easy on the fluids with these casualties.

It’s a jungle out there.

It is common these days for guys to gulp down as much isotonic drinks and gatorade than water after a long day in the sun especially when walking along old logging roads with little or no shade for 20-30 kilometers. Its a killer.

Thanks for your advice..much appreciated

[Doczilla]

We've moved away from salt tablets in preventing/treating heat casualties. SouthernDZ is exactly right in everything that he said. It is important that the soldier/potential patient continues to maintain adequate salt intake, particularly when water intake exceeds 4L/day. MREs have adequate salt content, so it's important to emphasize the need to eat their meals. They can't just drink and not eat anything. Monitoring urine output is a good way to monitor hydration status. The darker the pee, the more dehydrated they are. If they are humping for 8 hours without urinating once, they are dehydrated.

Forced water hydration, particularly more than 4L in a few hours, can potentially lead to hyponatremia (decreased sodium level), especially if there hasn't been adequate salt intake. Gatorade and Powerade are highly engineered drinks which provide some amount of sodium to prevent hyponatremia from overaggressive free water hydration. Gatorade has about 2x the sodium of Powerade, and about the same amount of potassium. Gatorade Endurance has double the amount of sodium and 3 times the amount of potassium of regular gatorade. I'd probably cut this latter formula with water.

Other than that, prevention of heat casualties relies on appropriate clothing, frequent rest breaks, protection from the sun, and early intervention on any illnesses that could potentially worsen dehydration, such as nausea, vomiting, diarrhea, fever, or infection. Make sure they drop their gear and fan themselves off frequently. In that weather, with lots of gear, drop for 10 minutes twice an hour.

Prevention and early recognition is key. As the casualty becomes nauseated, dizzy (particularly on standing), fatigued, suffers performance decrement, is confused, has difficulty thinking or solving problems, begins stumbling, is making poor decisions, is thirsty, has a high heart rate not related to exercise, they are dehydrated and potentially hyperthermic, and you should intervene. A high heart rate and no sweating in a confused or obtunded casualty means heat stroke, and they need to be cooled immediately and aggressively. As long as the casualty can drink and won't throw it up, you don't need an IV. Drink in small quantities as a time to prevent vomiting.

'zilla

Edit: hypERthermic, not hyPOthermic. My bad.

[hoot72]

Originally Posted by Doczilla

We've moved away from salt tablets in preventing/treating heat casualties. SouthernDZ is exactly right in everything that he said. It is important that the soldier/potential patient continues to maintain adequate salt intake, particularly when water intake exceeds 4L/day. MREs have adequate salt content, so it's important to emphasize the need to eat their meals. They can't just drink and not eat anything. Monitoring urine output is a good way to monitor hydration status. The darker the pee, the more dehydrated they are. If they are humping for 8 hours without urinating once, they are dehydrated.

Forced water hydration, particularly more than 4L in a few hours, can potentially lead to hyponatremia (decreased sodium level), especially if there hasn't been adequate salt intake. Gatorade and Powerade are highly engineered drinks which provide some amount of sodium to prevent hyponatremia from overaggressive free water hydration. Gatorade has about 2x the sodium of Powerade, and about the same amount of potassium. Gatorade Endurance has double the amount of sodium and 3 times the amount of potassium of regular gatorade. I'd probably cut this latter formula with water.

Other than that, prevention of heat casualties relies on appropriate clothing, frequent rest breaks, protection from the sun, and early intervention on any illnesses that could potentially worsen dehydration, such as nausea, vomiting, diarrhea, fever, or infection. Make sure they drop their gear and fan themselves off frequently. In that weather, with lots of gear, drop for 10 minutes twice an hour.

Prevention and early recognition is key. As the casualty becomes nauseated, dizzy (particularly on standing), fatigued, suffers performance decrement, is confused, has difficulty thinking or solving problems, begins stumbling, is making poor decisions, is thirsty, has a high heart rate not related to exercise, they are dehydrated and potentially hypothermic, and you should intervene. A high heart rate and no sweating in a confused or obtunded casualty means heat stroke, and they need to be cooled immediately and aggressively. As long as the casualty can drink and won't throw it up, you don't need an IV. Drink in small quantities as a time to prevent vomiting.

'zilla

Thanks Zilla

Much appreciated there..great amount of information there which will be extremely helpful...thanks once again guys!

[kachingchingpow]

Good info guys. Coaching youth football has it's hazards, particularly in the south where the temps are in the high 90's when practice starts. It breaks my heart every summer for the couple weeks of practice when a news story airs about some 13 or 15yo kid dying during practice. I think there were several in the state of GA last year alone. I can't emphasize enough to parents how to hydrate their kids off the field. I'll be incorporating some of the language in this thread into our notes to parents.