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Doctor’s Advice: Stay Cool this Summer


NIk NIkam

Dr. Nik Nikam

By Nik Nikam, M.D.

Center for Disease Control (CDC) reported 3442 deaths resulting from exposure to extreme heat, between 1999-2003 seasons. Pre-existing conditions such as heart disease or lung problems can compound the adverse effects of exposure to heat. Most of these deaths and injuries could be avoided

A Case in Point: It is 2 p.m, on a hot summer afternoon. Imagine, Shan, a 20-year-old boy playing baseball in the field all afternoon with smoldering heat and a temperature of 104 degrees. He collapses on the ground almost unconscious. He is rushed to a local emergency room at a nearby hospital. He is weak, barely able to talk. He complains of intense thirst while drenched in his own sweat and stuffed with his baseball gear. He is severely dehydrated; his eyes sunken, pulse weak, and blood pressure barely palpable. His electrolytes are grossly abnormal. Doctors and nurses rush to the scene, insert a large intravenous catheter; and pump 1 to 2 liters of balanced electrolyte fluid in minutes. Shan rubs his eyes while gazing at the ceiling and wondering what went wrong. It was a close call. He was experiencing heat exhaustion and was on the way to developing a more serious problem–heat stroke.

People involved in heavy physical exertion, while being exposed to extreme heat combined with humidity, tend to sweat a lot. The skin may feel warm, moist, and flushed. Other heat related symptoms include thirst, dehydration, rapid and weak pulse, low blood pressure, nausea, headache, and concentrated urine.

When you are exposed to extremes of heat, the skin temperature rises rapidly. The body tries to bring down the temperature by increasing the skin circulation to dissipate the heat. In the process, the body loses vital fluids and minerals. However, when you are working in an extremely hot and humid climate, the body cannot dissipate the heat effectively, and as a result, the core body temperature rises. There are three stages of heat related responses namely the heat cramps, the heat exhaustion, and the heat stroke.

Heat Cramps: You may develop muscle cramps which are the mildest form of heat related symptom. At this stage you may have sweating, fatigue, thirst, and muscle cramps. Sweating causes loss of sodium, potassium, and other elements that cause muscle cramps. This can easily be reversed by moving to a cooler area, taking rest, and drinking Gatorade or other type of drinks that have a combination of water and electrolytes that are essential to prevent muscle cramps.

Heat Exhaustion: This is a more advanced response to excessive heat. The person might be over dressed which prevents dissipation of heat. Alcohol may impair your body™s ability to regulate temperature. This may be the case on very hot days, where beach goers may be engaged in drinking alcohol. Alcohol also acts as a diuretic which leads to dehydration. As you get more dehydrated, the circulation to the skin is diminished, thus reducing your ability to dissipate the heat. This vicious cycle could lead to heat exhaustion or even heat stroke.

Children younger than 4 years and adults over the age of 65 are more prone for development of heat stroke. In young children their body responses are not well developed. In adults certain medications, such as Beta blockers may interfere with body™s adrenaline response to heat stress.  Diuretics may cause dehydration and reduce the circulating volume. Obesity may also interfere with your ability to handle heat.

Heat Exhaustion Treatment:

Move to a cooler place, away from the heat.

Avoid any activities that produce more heat in your body.

Remove heavy and tight clothes.

Use a fan to cool off your skin so that it can radiate more heat from the body.

Cool your body with a wet towel or take a cold shower.

Avoid alcohol.

Drink water or preferably Gatorade or any sports drinks that have balanced electrolyte solutions.

Elevate your legs above the heart level to return more blood to the main circulation to improve the blood pressure and increase cardiac output to dissipate the heat.

Cooling blankets are generally used in the hospitals to bring down the body temperature.

Heat Stroke: Heat stroke is a life threatening condition associated with body temperature in excess of 104 degrees. It is brought on by extreme heat or very strenuous activities. It needs immediate attention to prevent brain damage, organ damage, or even death. There is cessation of sweating. When the temperature is high, the skin may feel hot and dry. However, if the heat stroke is related to strenuous exercise, their skin may be warm and moist. Respirations may be rapid and shallow. The pulse may be feeble and rapid. Neurological symptoms may include seizures, loss of consciousness, hallucinations, mental confusion, or coma. Early muscle cramps may be later replaced by muscle rigidity.

The immediate danger of heat stroke is shock. Shock results when the intravascular volume decreases due to excessive sweating or fluid loss. There is also swelling of the organs such as the brain that can lead to permanent damage.

Diagnosis: Blood tests may show abnormalities of sodium and potassium levels. The urine may be dark and concentrated. The elevation of muscle enzymes may reveal severe muscle damage such as rabdomyolysis.

Heat Stroke Treatment: This is a medical emergency. The immediate goal here is to bring down the body temperature as quickly as possible. One such technique is immersing the body in a cold-water tank. However, this would interfere with other urgent medical treatments that need to be addressed such as hydrations etc. Sprinkling mist on the skin while running a fan might help to bring down the temperature. A more modern approach is to use cooling blankets which can lower the temperature to desired levels quickly and easily without any mess. It does not interfere with other treatment modalities. Excess muscle shivering (shivering releases the heat that is evaporated by the skin), may be counteracted by muscle relaxants.


Beware of the heat related symptoms and how to recognize them.

Wear loose and well-ventilated clothes.

Avoid extremes of heat.

Use sun tan lotion all over the body to prevent sunburn.

If your air conditioner breaks (which generally happens) on the hottest day, try to spend time in a mall or a library during the day time and use a fan in the evening and night hours.

Drink plenty of fluids.

If you are dehydrated, you may want to hold your water pills and consult with your physician.

Note that your car™s inside temperature could reach 160 degrees during hot and humid days. Never leave your children in the car, even if it is for a few minutes as it can prove to be dangerous.

When you get in your car that has been baking for hours in hot weather, don™t drive your car immediately off the lot. Roll your windows down, turn your cooler on, and let the hot air move out of the car. Let the air conditioner run for a few minutes before you get on the road.

Take extra precaution, if you move from a cooler climate to a hotter climate, as it may take several weeks for your body to get acclimatized to the new weather changes. This is especially true for older individuals who may move from Maine to Miami.

Disclosure: The information provided here is for educational purpose only. Please consult with your physician for any medical advice.Visit for more information or call281-265-7567 or email