Mariana Homoş, Violeta Melinte, Valentina Simion, Carmen Bărbulescu, Cristina Calomfirescu, Adriana Moţoc, E. Ceauşu
Spitalul de Boli Infecţioase şi Tropicale “Dr. Victor Babeş”, Bucureşti
Abstract
Background: In Bucharest area (Baneasa), during 15-25 July 2007, there were officially recorded temperatures between 33-39ºC, with more than 90% relative humidity over. That maximized the addressability to emergency medical services, the risk for alteration of some chronic diseases and heat exhaustion occurrence. Objectives: The study consisted in emphasizing clinical and evolutive traits of heat exhaustion/ heat stroke diagnosed patients, being aware about some preexisting risk factors. Material and methods: We diagnosed heat exhaustion/ heat stroke on 24 subjects, during 22 of July and 9th of August, on the basis of axillary high temperature, excluding other infectious causes. Results: The patients were over 57 years old, ranging from 57 to 96 years old, and sex distribution was almost equivalent. Most of them were Bucharest residents, 18 were living in blocks of flats, with no air conditioning systems. Associated chronic diseases were hypertension (15), obesity (12), neurological diseases (11), and diabetes mellitus (4). Clinical manifestations consisted in fever (38,5-42ºC), important alteration of general status, anhydrosis (14). The biologic profile was composed by initial hyperglycemia, except those with diabetes, leukocytosis and/ or hyponatremia. The treatment consisted in physical cooling, antipyretics, antibiotics, parenteral hydratation, corticoids, in some cases dopamine, diazepam, even diuretics. Evolution was favorable for 10 patients only, the rest died one hour to 90 hours later, after admittance. Conclusions: 1. Extremely high environmental temperatures correlate proportionally with chronic diseases alteration and heat exhaustion/ heat stroke occurrence – specific pathology. 2. Predisposing associated chronic diseases were hypertension, Parkinson disease, obesity, and diabetes mellitus. 3. Fever over 40ºC and coma were the most important factors for poor outcome. 4. Moving to a shaded area and starting cooling by best means available are the most important therapeutic measures. 5. Antipyretics are inefficient. 6. Obese patients died in a greater amount than those with neurological diseases or hypertension, most of them being men (9/11).