Heatstroke: Marathons to Mecca

Abstract

Heatstroke is a critical condition caused by excessive heat exposure producing high body temperatures and central nervous system symptoms. It can be associated with high mortality. Classical heatstroke is often seen in elderly patients with associated illnesses. In heat waves, this can reach epidemic proportions [1]. Exertional heatstroke is seen more often in young, healthy individuals and is characterized by marked dehydration and enzymatic changes [2]. This type tends to be more sporadic but can occur in epidemic fashion e.g. marathon events and military exercises. If overheating is detected immediately and body temperature is lowered, heat syncope or heat exhaustion may not progress to heatstroke. During the Papal visit in 1993 at Denver Colorado USA, 10–20000 people collapsed. 300 were hospitalized with only one fatality as the direct result of immediate cooling at the site (Denver Post, 16 APR 93). At Parris Island USA, each year 10–30 marines succumb to exertional heatstroke during basic training and are immediately treated with no fatalities [3]. If heating continues, the full blown multi-system syndrome can occur with widespread tissue death and high mortality. Such is the case with heat waves in urban areas [1], confinements of illegal aliens in trucks [4], accidents such as the “black hole of Calcutta” and military campaigns [5].