Recommendations for Replacing Water and Salt
Two types of heat exhaustion are commonly seen among athletes and soldiers: water depletion WD and salt depletion SD. Although both are caused by a shrunken plasma volume, the most effective medical treatment is slightly different for each. WD occurs rapidly, usually within one day. It involves prominent thirst because blood is concentrated due to excessive water loss in sweat. Dilute fluids or pure water are effective in bringing the body’s extracellular fluid back to its normal homeostasis. SD takes – days to develop because salt losses in sweat and urine eventually exceed the dietary salt content. Thirst is seldom observed in SD; body fluids are dilute and blood sodium
Heat exhaustion is marked by the inability to continue exercise in the heat levels are low. However, muscle cramps, vomiting, and progressive weakness are common. To replace the proper nutrients, salt and water losses can be estimated as of NaCl andL of water per hour. The fluids that are used to treat SD should, therefore, contain an appropriate amount of NaCl and should not consist of pure water.
Heat exhaustion, characterized by prominent fatigue and progressive weakness, can be distinguished from exertional heatstroke, which is a medical emergency involving life-threatening hyperthermia Tre greater than -C, -F. Tablepage compares the distinguishing characteristics of these illnesses. Appendix B offers further information.
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Characteristics of Exertional Heatstroke
The first of the distinguishing factors, blood enzymes, are used clinically as markers of organ damage in numerous diseases. Their chemical names are usually abbreviated ACT, AST, CPK, LDH. Enzymes are proteins that normally reside inside cells, where they serve to speed chemical reactions. Enzyme levels in the blood rise because damage to cell membranes has occurred. The most likely cause of membrane disruption is hyperthermiathe noxious agent in exertional heatstroke. In fact, if you compare the first two diagnostic factors in table you will see that blood enzyme levels rise as Tre rises. The third factor in this table relates to the body’s ability to spontaneously dissipate heat see How Your Body Loses Heat, pageIn mild cases of heat exhaustion, the rate of heat loss is normal and approximately equals metabolic heat production. In severe cases of heat exhaustion, heat dissipation is overwhelmed by heat production because sweating and cardiovascular compensation do not adequately remove the heat generated during exercise when body temperature is moderately elevated. In exertional heatstroke, the central nervous system is impaired by the extreme temperature of nerve cells, especially when body temperature is aboveF. This scrambles or reduces the number of impulses sent from the brain to the sweat glands and blood vessels, thereby impairing heat loss via sweat evaporation, radiation, and convection. Interestingly, the central nervous system seems to be the most heat sensitive of all of the body’s systems. This explains the fourth factor in table Mental acuity and consciousness are markedly affected by hyperthermia. This provides the best way to quickly distinguish heat exhaustion from exertional heatstroke. If tests of mental status carrying on a coherent conversation, answering simple questions indicate confusion or loss of acuity, heatstroke should be expected and rapid whole-body cooling should commence immediately. Remember that of skeletal muscle are linked with either large losses of NaCl in sweat, replacement of sweat losses with a large volume of dilute fluid/pure water, or both. All of these situations cause the extracellular fluid, and the intracellular fluid after a few hours, to become diluted. The expansion of intramuscular water is believed to be the critical factor in the development of heat cramps. Indeed, an increase of intramuscular water has been observed during heat acclimation while consuming a low-sodium diet, via analysis of muscle biopsies. A shift in the intracellular-extracellular ratio of NaCl and water will alter the electrical properties of muscle membranes, and could alter muscle contraction or relaxation. Although the exact mechanism of any muscle cramp writer’s cramp, nocturnal foot cramp is unknown, research suggests that heat cramps are related to salt imbalance. For example, Leithead and Gunn reported that the urine of healthy field laborers contained NaCl/L, but the urine of laborers with heat cramps contained only g/L. The smaller amount ofNaCl in the urine of the heat cramp patients suggests that their kidneys were reabsorbing sodium, under the influence of the hormone aldosterone, because of the whole-body deficit. Similarly, Talbot observed blood sodium levels ranging from to mEq/L in heat cramp patients; because the normal range in healthy adults is to mEq/L, these patients showed severe to moderate sodium deficits. Heat cramps may be confused with other forms of muscle cramps. They usually occur in the large muscles, limbs, or in the abdominal muscles. Unlike ordinary exercise-induced muscle cramps, heat cramps begin as feeble, localized spasms and may appear to wander over the muscle, as adjacent motor units become involved. They occur in – of SD heat exhaustion patients.
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