Reversal of heatstroke pathophysiology

In surgical patients with low tissue oxygen tension, intravenous infusion of a small volume of normal saline results in a prompt rise in tissue oxygen tension readings. The administration of a cold intravenous infusion of less than 1 liter over less than 1 h has led to a significant reduction in blood temperature and general clinical improvement in heatstroke patients (Kashmeery 1995b). A significant reduction in the abnormally elevated venous oxygen content, implying an improved oxygen extraction ratio, is also seen in these patients. Owing to its established lag, reliance on rectal temperature should be minimized. Mild external body cooling eliminates shivering, which usually exacerbates the problem by accumulating further heat to the body core.

In hypovolemic shock the kidneys autoregulate. In heat exhaustion patients, who manifest minimal signs of hypovolemia, urine flow is sharply diminished. It is generally accepted that tissues like intestine and skin are peripheral and therefore dispensable in the hierarchy of blood-flow-demanding tissues under stressful conditions. Although the kidneys are as heavily innervated by the autonomic nervous system as these other tissues, they maintain adequate blood flow even under severe hypovolemia. Thus diminished urine flow associated with heat illnesses is not likely to be due to blood flow.

Oxygen extraction appears to be one of the important factors in the pathogenesis of heatstroke. Thus improvement in maximizing oxygen extraction and utilization, which is reflected in a large arteriovenous oxygen difference, can be crucial and life saving. Unless corrected early, the pathophysiology continues with significant morbidity and mortality.

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