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Hyperthermia
Zhang Yinglan
MD, Associate chief physician
Emergency Department
Longhua Hospital Affiliated Shanghai
University of TCM
What is hyperthermia?

It is an acute heat injury disease resulting from
prolonged exposure to high environmental
temperature which causes a dysfunction of the
temperature-regulating mechanism and
excessive loss of water-electrolyte of the body.
Causitive Factors

high temperature climate

dry-heat working condition and high humid-warm
environment

dysfunction of the temperature-regulating mechanism
•
increased heat production
•
poor heat adaptation
•
impedient heat dissipation
Causitive Factors
High temperature condition
temperature＞32℃
humidity＞ 60％
poor ventilation
Long time or high-intensitive work
Etiological Factors

Obtain excessive external heat
Increased heat production

Iimpedient heat dissipation

Dysfunction of the sweat gland
Severe potassium deficiency


pathogenesis
Heat production


Oxidative metabolism
Muscle contraction
Heat dissipation (15-25℃)




Radiation 60%
Evaporation 25%
Convection 12%
Conduction 3%
Regulation of heat production and
dissipation
Radiation
Convection
＆
•the major way of heat dissipation
•depends on the difference between the body surface and
environmental temperature（ 15-25℃ →60％， 33℃ →0% ）
the most heat dissipation part of the body is head（50%），
then hands and feet
•depends on the air flow rates
•the conduction power of water is 240 times than the air
Conduction
Evaporation
•1g water evaporation for 2.4kj（0.58kcal）heat dissipation
•more humidity less evaporation
The influence of hyperthermia
on the human body
central nervous system

inhibiting effect
•
inattention
•
slow in reacting
•
decreased accuracy and Coordination of action

dysfunction
•
delirium、 mania
•
coma
cardiovascular system

arrhythmia

heart failure

decreased cardiac output
respiratory system

respiratory alkalosis

ARDS
water-electrolyte metabolism

loss of water and sodium and chlorinum
urinary system

reduction in renal blood flow and
glomerular filtration rate
•
proteinuria and cylindruria

rhabdomyolysis（横纹肌溶解）
•
myoglobinuria（肌红蛋白尿）
•
acute renal failure
Diagnosis
Severe heatstroke
Mild heatstroke
Premonitory heatstroke
Prodrome



High temperature environment
Thirsty、fatigue、 excessive sweating、 dizziness、
headache、palpitation、nausea…
The body temperature is about normal or slightly high
Mild Hyperthermia



The exacerbation of premonitory hyperthermia
The early stage of dysfunction of the circulation：
flushed face or pale complexion、 dysphoria or
apathia 、nausea and vomiting 、 sweating 、
clammy skin, 、thin and rapid pulse、
hypotension 、 increased heart rate
The body temperature is slightly increased
Severe Hyperthermia
type

heat cramps

heat exhaustion

heat stroke
high temperature
heat
cramps
sweating a lot
excessive loss of water and salinity
supply more water but less salinity
hyponatremia and hypochloremia
muscle cramp、pain（water loss ＞ salinity loss）
excessive expansion of peripheral vascular
heat
exhaustion
collapse、shock
temperature＞42℃ → protein denaturation
body temperature＞50℃ → all cell death a few
minutes later
during the autopsy, pathological change can be
seen in the brain、 neurocyte 、 cardiomyocytes
、lung、liver、kidney and hemorrhagic spots can
be found in the pleura、 peritoneum 、small
intestine，etc
body
heat
stroke
Clinical symptoms of severe
hyperthermia
Heat cramps

it refers to a severe muscle cramp and contraction pain
（the muscle of four limbs and abdomen）

it happens at the beginning of the hot season and before
the heat adaptation of the body

young people who do manual work under the high
temperature circumstance and sweat a lot
Heat exhaustion

acute onset

dizziness, headache, suddenly faint , pale complexion ，
cold sweat in the skin, weak or slow pulse, hypotension
but with normal pulse pressure

awake after lie on the back or leave the high temperature
environment

old people or individuals with heat intolerance
Heat stroke

typical symptoms：hyperpyrexia , anidrosis ,
disturbance of consciousness

prodrome：fatigue, dizziness, headache, nausea,
sweat reduced

body temperature increases rapidly（＞41℃） →
somnolence, apathy, coma

hot and dry skin ，no sweat， flushed or pale skin ，
or even cyanosis
Heat stroke

pulse quicken ， increased pulse pressure ， decreased
blood pressure

arrhythmia

fast and shallow breathing ，Chyne-Stokes respiration

muscle twitches

pupil contraction ，pupillary light reflex disappear
Heat stroke
shock
heat stroke
heatfailure
arrhythmia
pulmonary edema
cerebral edema
liver and kidney failure
ARDS
gastrointestinal bleeding
DIC…
Laboratory examination
Heat cramps

blood natrium ↓

blood chlorine ↓

ucre urine creatine ↑
Heat exhaustion


hematocrit (HCT) ↑
hyponatremia 、 hypokalemia 、slight
azotemia or abnormal liver function
Heat stroke




hyperkalemia,
hypercalcemia,
hemoconcentration,
leukocytosis , thrombocytopenia
Cr、BUN、AST、ALT、LDH、CPK ↑
proteinuria , cylindruria, myoglobinuria , acidosis
EKG
Diagnosis
Heat cramps or exhaustion



exposure history to high temperature environment
symptoms：sweat a lot, muscle cramps, postural
syncope , transient fall of blood pressure
laboratory examination
Heat stroke

three characteristics
•
hyperpyrexial fever
dry and hot skin
severe central nervous system symptoms
•
•


acute onset
causitive factors
Differential diagnosis

diseases cause high fever and coma
•
cerebral malaria
Japanese encephalitis
meningitis
acute cerebrovascular disease
organic phosphorus pesticide poisoning
…
•
•
•
•
•
Evaluation of vital signs
1
causes
duration of the
injury
start time of
rescue

evaluate
2
severity
body temperature
disturbance of
water and
electrolyte

evaluate
3
consciousness
pulse
respiratory
bloodpressure
muscular tension
 urine volume

observation
Treatment
On-site treatment

leave the high temperature environment immediately

have a quiet rest in a shelter, loosen the clothing

drink some cold salty water

NS、GS、KCL ivgtt (for a circulatory failure patient)

no massage for the muscle cramp and contraction pain

electrolyte supplement

a positive rescue for a heat sroke patient
Hypothermia therapy
lower the temperature of
environment

cool and ventilated place

indoor temperature <20 oC
lower the temperature of the body
surface

rub the body surface

put the ice bag on the main artery(head, bilateral
carotid artery, armpit, groin)

avoid shivering

cold bath
lower the temperature of the central
body temperature

5％GS 1000～2000mlivgtt (4-10oC)

10％GNS 1000ml enema (4-10oC)

inject cold NS into the gastric tube
drug hypothermia

chlorpromazine 氯丙嗪

naloxone 纳洛酮

lower lower the body temperature till 38oC
(rectal temperature)

maintain the systolic pressure＞90mmHg
Emergency treatment
a cool and ventilated environment
cold salty drink
Chinese patent medicine（rendan mini-pills，
“ 10 drops ”， Huoxiangzhengqi tablets）
 acupoint massage with essential balm
（ Taiyang(EX-HN5)，Hegu（L14））
cold compress， alcohol bath
5％GNS1000－2000 ml ivgtt

Prodrome
&
mild
急救处理
热
痉
挛
在补足体液情况下，仍有四肢肌肉抽搐和痉
挛性疼痛，可缓慢静注10%葡萄糖酸钙
10ml＋维生素C 0.5。
Emergency treatment
circulation
collapse
5％GNS2000－3000ml

ivgtt quickly
vasopressor（ dopamine， aramine）
maintain the systolic pressure＞90mmHg
Emergency treatment
heart
stroke
physical
hypothermia
drug hypothermia（chlorpromazine）
 naloxone treatment（naloxone 0.8mg +25%
GS20ml iv）
symptomatic and supportive treatment
prevent from cerebral
edema
fluid infusion
oxygen
Emergency
treatment
ventilation
low temperature
hypothermia
comprehensive and
supportive treatment
symptomatic treatment

respiratory function

circulatory function

cerebral edema

renal dysfunction

hepatic dysfunction

DIC

water-electrolyte and acid-base balance

intensive nursing
prevention and treatment of
multiple organs failure

lower the central body temperature as soon as
possible


decrease the metabolic rate
complication treatment
Prognosis

mortality：20% -70%

the worst type：heat stroke

sequela
•
mild neural dysfunction
•
several weeks of muscular weakness
•
permanent brain damage
Prevention
TCM treatment
Heat-clearing drinks
hawthorn
tea（山楂汤）
hawthorn 100g, dark plum 50g, feverfew20g
iced water melon juice
sweet mung bean soup and plum juice（绿豆酸梅汤）
lotus leaf tea
fresh lotus leaf10g, baizhu10g, huoxiang6g, gancao6g
lonicera japonica tea（金银花汤）
Chinese patent medicine
mini-pills 人丹
“10 drops”(a popular medicine for summer aliments)
十滴水
 essential balm清凉油
Rendan
thank you！