OK I lost it...heat stroke and heat exhaustion.

[Veneficus]

Little different, but SIADH and DI are more about free water balance then disturbances in electrolyte absorption/secretion, despite the abnormal sodium lab findings.

Different from what's being discussed above as far as sweating and exertional losses where you're losing electrolytes that need to be replaced.

If my memory serves me correct, it(including electrolyte absorbtion) was all covered under free water in some or another textbook I had to read along the way.

Right down to the number of attached water molecules.

 

[FLdoc2011]

If my memory serves me correct, it(including electrolyte absorbtion) was all covered under free water in some or another textbook I had to read along the way.

Right down to the number of attached water molecules.

Not quite sure the specifics you are referring to... but all along the nephron are transporter proteins that pump in/out Na/Cl/K thus setting up concentration gradients allowing electrolyte and water secretion or reabsorption to occur. So not really a certain water molecule "attached" to say a Na. Though because of osmotic/osmolality forces where Na goes water usually follows.

 

[Veneficus]

Not quite sure the specifics you are referring to... but all along the nephron are transporter proteins that pump in/out Na/Cl/K thus setting up concentration gradients allowing electrolyte and water secretion or reabsorption to occur. So not really a certain water molecule "attached" to say a Na. Though because of osmotic/osmolality forces where Na goes water usually follows.

"attached" to quantify the osmotic/osmolality.

 

[mycrofft]

IN vivo, por favor.

 

[Veneficus]

IN vivo, por favor.

I think it comes down to looking at the relative concentrations.

just quick and dirty,

for every molecule of NA, Cl, K, and glucose transported back into the body, it is estimated at 20 molecules of water each. (I imagine this is an average so there will be some deviation)

If you go with 100 molecules of water, or even convert to moles if it suits you, with one of each above, you are reabsorbing about 80% of the water in the renal tubule.

A combination of solubility, osmolality, and active transport. It is why basic science is the base of medicine and a good example on how to apply it.

I am of the opinion that people who were not taught how to apply basic science to clinical practice and see it as two seperate things should probably go back to where they went to school and demand some money back because the teachers there were not doing their job.

 

[mycrofft]

My school was not very good at bridging from basic science to clinical realities, but I had some OK clinical instructors and a couple good EMT teachers and a long memory (then).

I put down my crossword puzzle and the Kindle with Teddy Roosevelt's history of the naval war of 1812 an dread all the posts here. Mia apologia, I wasn't getting it; however, I did note empirically in the field that people who had heat related illness did not eat their meals.

So, if someone is depleted in both electrolytes AND water ("sweated-out"), could a too-rapid infusion or ingestion of water produce water intoxication (below the amount customarily associated with it)?

 

[Veneficus]

My school was not very good at bridging from basic science to clinical realities, but I had some OK clinical instructors and a couple good EMT teachers and a long memory (then).

I put down my crossword puzzle and the Kindle with Teddy Roosevelt's history of the naval war of 1812 an dread all the posts here. Mia apologia, I wasn't getting it; however, I did note empirically in the field that people who had heat related illness did not eat their meals.

So, if someone is depleted in both electrolytes AND water ("sweated-out"), could a too-rapid infusion or ingestion of water produce water intoxication (below the amount customarily associated with it)?

I have heard of severely dehydrated being infused with NS getting hypernatremic, but never water intoxicated.(aka hyponatremia)

 

[mycrofft]

The human body is a contrary and strangley adaptable mechanism .

 

[hippocratical]

So... The following is correct then? Basically that is...

Heat exhaustion: Symptoms caused primarily by dehydration and hypovolemia due to excessive sweating

Heat Stroke: If your body is unable to cool you below an internal temp of 41C then your enzymes start denaturing which'll kill ya quick

I'd like to know.

 

[the_negro_puppy]

So... The following is correct then? Basically that is...



I'd like to know.

Yes this is what we are taught. Our clinical practice manual states:

Heat exhaustion:

Core temp > 38 C - 40 c (but not always)
Pale or flushed sweaty skin (become dry as progresses to heat stroke)
Tachycardia
Possible hypotension
Nausa
Vomiting
Tachypnea
fatigue, dizziness, thirst

Heatstroke:
Core temp > 40 C
Altered conscious state
Hot dry skin
Vomiting
Tachycardia, hypotension
Seizures
Dilated pupils
Hypoglycemia
possible dysrhytmias

 

[Akulahawk]

Remember, the big problem with heatstroke is that the core temp goes high because the body can't cool itself down effectively enough. While the "book" gives a definition as to which is which, the line between the two problems can very much blur. Your patient can very easily have components of each... and be very much in trouble. NOT a good place for the patient to be if the field provider sticks to the definitions of the two fairly rigidly...

 

[mycrofft]

Well, not that big a difference in reality. Cool them down, and if it the pt's red and dryish, cool them down aggressively. Then hospitalize.

Sometimes "five is four". Either way they ought to see a MD, just when it's heat exhaustion get it done mui quick-o.

 

[Akulahawk]

The field care really isn't much different, however much time may be wasted trying to decide which is which. Here in Sacramento, we have a hyperthermia protocol... it basically states that if sweating is absent, then you proceed to cooling the patient as rapidly as possible. The problem is that sometimes the heatstroke patient hasn't lost the ability to sweat yet so all you'd do is just put those patients in a cool area instead of aggressively cooling them. You have to understand when your patient is starting to cross into heatstroke and begin aggressive cooling to prevent them from getting that hot to begin with. At least there's an order for IV and titration to SBP of 90-100...

So, while there's a nice protocol that kind of takes that decision-making out of your hands as to which problem the patient has, the protocol drives the decision about aggressive cooling at presence or absence of sweating instead of actually determining what problem the patient does have and going from there.

 

[mycrofft]

Ought to be body temp not sweat. That was criteria when we had the heatwave in Nebraska, 1981, rectal temp. Tx: ice filled life raft.

 

[Akulahawk]

Ought to be body temp not sweat. That was criteria when we had the heatwave in Nebraska, 1981, rectal temp. Tx: ice filled life raft.

I agree. Should be body temp driven, not sweat...

 

[mycrofft]

Better...both. "Either/and" deal.

 

[Sandog]

Well, if sweat is not present, you got a pretty good idea there is a problem.

 

[mycrofft]

Could be "perfectly" balanced homeostatic thermoregulation...which means, ten minutes to dehydration.

 

[mycrofft]

Could be "perfectly" balanced homeostatic thermoregulation...which means, ten minutes to dehydration.

I kid you not; we had a unit readiness eval in 80+ F wether, humidity in the thirties, and strenuous exercise in MOPP 4 (full chem suits, and not allowed to de-suit), and when I had the whole bunch lay prone on shady cool concrete and they had to get back up, the concrete looked like some sort of installation art. Dozens of human outlines that quickly evaporated.

 

[hippocratical]

Good to know, thanks!

I thought so, as you could push a perfectly hydrated person dressed in a sealed HAZMAT suit into an oven, and they get heat stroke because their body simply cant deal with the heat, rather than an electrolyte/volemia issue.

Wouldn't want to be that guy...