Chapter 681 Heat Injuries

Heat illness is the 3rd leading cause of death in U.S. high school athletes. It is a continuum of clinical signs and symptoms that can be mild (heat stress) to fatal (heatstroke) (Chapter 64). Children are more vulnerable to heat illness than adults. They have greater ratio of surface area to body mass than adults and produce greater heat per kilogram of body weight than adults during activity. The sweat rate is lower in children and the temperature at which sweating occurs is higher. Children can take longer to acclimatize to warmer, more humid environments (typically 8-12 near-consecutive days of 30-45 min exposures). Children also have a blunted thirst response compared to adults and might not consume enough fluid during exercise to prevent dehydration.

Three categories for heat illness are generally used: heat cramps, heat exhaustion, and heat stroke. However, symptoms of heat illness overlap and advance as the core temperature rises. Heat cramps are the most common heat injury and usually occur in mild dehydration and or salt depletion, usually affecting the calf and hamstring muscles. They tend to occur later in activity, as muscle fatigue is reached and water loss and sodium loss worsen. They respond to oral rehydration with electrolyte solution and with gentle stretching. The athlete can return to play when ability to perform is not impaired. Heat syncope is fainting after prolonged exercise attributed to poor vasomotor tone and depleted intravascular volume, and it responds to fluids, cooling, and supine positioning. Heat edema is mild edema of the hands and feet during initial exposure to heat; it resolves with acclimatization. Heat tetany is carpopedal tingling or spasms caused by heat-related hyperventilation. It responds to moving to a cooler environment and decreasing respiratory rate (or rebreathing by breathing into a bag).

Heat exhaustion

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