Abstract
Exertional heat exhaustion (H EX) is the most prevalent form of heat illness in athletic, industrial, and military settings. The common etiological features include dehydration, high ambient temperature/humidity/solar radiation with slow air movement, and strenuous/prolonged exercise. The fundamental pathophysiology of H EX involves total body water and whole-body sodium deficits, mild hyperthermia, and great cardiovascular strain. Although some authorities believe that H EX represents only postural hypotension leading to collapse, numerous clinical and physiological publications have described H EX in a variety of scenarios and concluded that H EX involves more than postural hypotension per se. Recognition of H EX focuses on great fatigue or muscular weakness, mild rectal temperature elevation, nausea, vomiting, and the signs and symptoms that reflect dehydration (i.e., whole-body sodium and body water deficits) plus circulatory insufficiency (e.g., hypotension, ashen skin). When H EX patients collapse and/or exhibit altered mental status, severe H EX is indicated; they have reached the limits of cardiovascular compensation, and hyperthermia adds additional stress to existing cardiovascular insufficiency. Mild H EX with no other symptoms may be treated with rest and leg elevation, but severe H EX cases that involve large fluid losses and tachycardia at rest should be treated by judicious administration of intravenous fluid, under supervision of a physician. Exercise-heat acclimatization across 8–10 days improves orthostatic intolerance, enhances cardiovascular stability, reduces salt losses in sweat and urine, and expands plasma (extracellular) volume; the resulting adaptations improve heat tolerance and enhance ability to work and exercise in the heat.
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Armstrong, L.E. (2020). Heat Exhaustion. In: Adams, W., Jardine, J. (eds) Exertional Heat Illness. Springer, Cham. https://doi.org/10.1007/978-3-030-27805-2_5
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