Dehydration in Adults

Dehydration in Adults Overview

Dehydration is a condition that can occur when the loss of body fluids, mostly water, exceeds the amount that is taken in. With dehydration, more water is moving out of individual cells and then out of the body than the amount of water that is taken in through drinking. Medically, dehydration usually means a person has lost enough fluid so that the body begins to lose its ability to function normally, and begins to produce symptoms related to the fluid loss.

People (and animals) lose water every day in the form of water vapor in the breath we exhale, and as water in our sweat, urine, and stool. Along with the water, small amounts of salts or electrolytes are also lost. Our bodies are constantly readjusting the balance between water (and salts or electrolytes) losses with fluid intake. When we lose too much water, our bodies may become out of balance or dehydrated. Most doctors divide dehydration into three stages: 1) mild, 2) moderate and 3) severe. Mild and often even moderate dehydration can be reversed or put back in balance by oral intake of fluids that contain electrolytes (or salts) that are lost during activity. If unrecognized and untreated, some instances of moderate and severe dehydration can lead to death. This article is designed to discuss dehydration in adults.

Causes of Dehydration in Adults

Many conditions may cause rapid and continued fluid losses and lead to dehydration. 

• Fever, heat exposure, and too much exercise
• Vomiting, diarrhea, and increased urination due to infection
• Diseases such as diabetes
• The inability to seek appropriate water and food (an infant or disabled person, for example)
• An impaired ability to drink (someone in a coma or on a respirator, or a sick infant who cannot suck on a bottle are common examples)
• No access to safe drinking water
• Significant injuries to skin, such as burns or mouth sores, severe skin diseases, or infections (water is lost through the damaged skin)

In addition to drinking water, the body also needs replacement of electrolytes lost with the above mentioned conditions, so drinking water without electrolyte replacement may not complete the balance of water and electrolytes the body has lost. Some symptoms (see below) may remain if this balance is not restored.

Symptoms of Dehydration in Adults

The signs and symptoms of dehydration in adults range from minor to severe. Mild to moderate dehydration may include the following:

• Increased thirst
• Dry mouth
• Tired or sleepy
• Decreased urine output
• Urine is low volume and more yellowish than normal
• Headache
• Dry skin
• Dizziness
• Few or no tears

The above symptoms may quickly worsen to indicate severe dehydration with signs and symptoms as follows:

• Severely decreased urine output or no urine output. The urine, if any, produced is concentrated and a deep yellow or amber color.
• Dizziness or lightheadedness that does not allow the person to stand or walk normally.
• Blood pressure drops when the person tries to stand after lying down (low blood pressure)
• Rapid heart rate
• Fever
• Poor skin elasticity (skin slowly sinks back to its normal position when pinched)
• Lethargy, confusion, or coma
• Seizure
• Shock

When to Seek Medical Care

Call a primary care doctor if the affected individual with potentially mild to moderate dehydration experiences any of the following:

• Increased or constant vomiting for more than a day
• Fever over 101 F (38.3 C), but less than 103 F (39.4)
• Diarrhea for more than 2 days
• Weight loss
• Decreased urine production
• Weakness

Take the person to the hospital's emergency department if these situations occur:

• Fever higher than 103 F (39.4)
• Confusion
• Lethargy
• Headache
• Seizures
• Difficulty breathing
• Chest or abdominal pain
• Fainting
• No urine in the last 12 hours

Dehydration in Adults Diagnosis

The doctor may perform a variety of simple tests at the time of examination or send blood or urine samples to the laboratory. Through tests and examination, the doctor will try to identify the underlying cause or causes that led to the dehydration.

Vital signs

• Fever, increased heart rate, decreased blood pressure, and faster breathing are signs of potential dehydration and other illnesses.
• Taking the pulse and blood pressure while the person is lying down and then after standing up for 1 minute can help determine the degree of dehydration. Normally, when a person has been lying down and then stands up, there is a small drop in blood pressure for a few seconds. The heart rate speeds up, and blood pressure returns to normal. However, when there is not enough fluid in the blood because of dehydration and the heart rate speeds up, not enough blood is getting to the brain. The brain senses this condition. The heart beats faster, and if the person is dehydrated, they often feel dizzy and faint after standing up.

Urinalysis

• The color and clarity of urine, the urine specific gravity (the mass of urine when compared with that of equal amounts of distilled water), and the presence of ketones (carbon compounds - a sign the body is dehydrated) in the urine may all help to indicate the degree of dehydration.
• Increased glucose in the urine may lead to a diagnosis of diabetes or indicate loss of diabetic control and a cause for the dehydration.
• Excessive protein may signal kidney problems.
• Signs of infections or other diseases, such as liver disease, may be found.

Blood chemistries

• The amount of salts or electrolytes (sodium, potassium, bicarbonate) and glucose as well as indicators of kidney function (BUN and creatinine) may be important to evaluate the degree of dehydration and possible causes.
• A complete blood count (CBC) may be ordered if the doctor thinks an underlying infection is causing the dehydration. Other blood tests, such asliver function tests, may be indicated to find causes of the symptoms.

Dehydration in Adults Treatment

Dehydration in Adults Self-Care at Home

Try to get people who are dehydrated (even those who have been vomiting) to take in fluids in the following ways:

• Sip small amounts of water.
• Drink carbohydrate/electrolyte-containing drinks. Good choices are sports drinks such as Gatorade or prepared replacement solutions (Pedialyte is one example).
• Suck on popsicles made from juices and sports drinks.
• Suck on ice chips.
• Sip through a straw (works well for someone who has had jaw surgery or mouth sores).

Try to cool the person, if there has been heat exposure or if the person has an elevated temperature in the following ways:

• Remove any excess clothing and loosen other clothing
• Air-conditioned areas are best for helping return the affected individual's body temperature to normal and break the heat exposure cycle.
• If air-conditioning is not available, increase cooling by evaporation by placing the person near fans or in the shade, if outside. Place a wet towel around the person.
• If available, use a spray bottle or misters to spray tepid (luke-warm) water on exposed skin surfaces to help with cooling by evaporation.
• Avoid exposing skin to excessive cold, such as ice packs or ice water. This can cause the blood vessels in the skin to constrict and will decrease, rather than increase heat loss. Exposure to excessive cold can also cause shivering, which will increase body temperature, this may cause the dehydration symptoms to become worse.

Dehydration in Adults Medical Treatment

Treatment in the Emergency Department centers first on restoring fluid (blood) volume and electrolytes, and treating any life-threatening symptoms while also trying to determine the underlying cause(s) of the dehydration.

If the affected individual's core body temperature is greater than 104 F (40 C), doctors will cool the entire body. They may promote cooling by evaporation with mists and fans or cooling blankets and baths.

Fluid replacement in moderate to severe dehydration

• If there is no nausea and vomiting, fluid replacement may begin orally for some patients with moderate dehydration. Patients are asked to drink electrolyte/carbohydrate-containing fluids along with water.
• However, if there are signs of moderate to severe dehydration (elevated resting heart rate, low blood pressure), fluids are generally given through an IV.

Disposition

• If the patient's condition improves enough (most symptoms stop) in the Emergency Department, the patient may be sent home, preferably in the care of friends or family. This is not an unusual result for many patients that arrive at an Emergency Department with moderate dehydration symptoms.
• If the patient remains dehydrated, confused, feverish, has persistently abnormal vital signs, or signs of infection, they will likely be admitted to the hospital for additional treatment.

Acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil) may be used. This can be given by mouth if the affected person is not vomiting, or as a rectal suppository if they cannot take anything by mouth.

Dehydration in Adults Medications

If fever is a cause of dehydration, the use of acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil) may be used. This can be given by mouth if the patient is not vomiting, or as a rectal suppository if the patient cannot take anything by mouth. Intravenous (IV) fluids and IV medication, including some that include electrolytes or medications that help normalize electrolyte levels are often used. Other IV medications may need to be used underlying causes of dehydration (for example, IV antibiotics for dehydration caused by infection).

Dehydration in Adults Follow-up

• Call or return to your doctor or the hospital as instructed.
• Take prescribed medications as directed.
• Continue to keep the affected individual well hydrated with plenty of sports drinks and water.
• Watch for signs of dehydration in yourself and others.

Dehydration in Adults Prevention

• Plan ahead and take extra sports drinks that contain electrolytes and water bottles to all outdoor events and work areas where increased sweating, activity, and heat stress will likely increase a person's fluid loss. Encourage athletes and outdoor workers to replace fluids at a rate that equals the loss.
• Avoid exercise and exposure during high heat index (high air temperature with high humidity) days. Listen to weather forecasts for high heat stress days, and plan events that must occur outside during times when temperatures are cooler, usually in the early AM and after sunset..
• Ensure that older people and infants and children have adequate drinking water and fluids containing electrolytes available, and assist them as necessary. Make sure that any incapacitated or impaired person is encouraged to drink and is provided with adequate fluids.
• Avoid alcohol consumption, especially when it is very hot, because alcohol increases water loss and impairs a person's ability to sense early signs associated with dehydration.
• People should wear light-colored and loose-fitting clothing if they must be outdoors when it is hot outside. Carry a personal fan or mister to cool the body so less fluid is lost through sweating.
• Limit the time a person is exposed to hot temperatures. Find air-conditioned or shady areas and allow the body to cool between exposures. Taking someone into a cooled area for even a couple of hours each day will help prevent the cumulative effects of high heat exposure.

Clemson University has developed recommendations for fluid intake when a person needs to endure outside activity in hot weather:

Drink the following amounts of fluids when exercising rigorously or in very hot weather:

• Two cups during the two hours before exercising; 1 to 2 cups within 15 minutes of the activity
• One half to 1 cup every 15 to 20 minutes during exercise (One medium mouthful of fluid equals about 1 ounce, and 8 ounces equals 1 cup.)
• Drink 3 cups for each pound of body weight lost.

Dehydration can be prevented by making the decision to take actions to stay well hydrated.

Tetanus: Make Sure You and Your Child Are Fully Immunized

Playing outdoors can mean getting cuts that may become infected with bacteria commonly found in soil, including the ones that cause tetanus. Tetanus vaccine can help prevent tetanus disease, commonly known as "lockjaw.

Tetanus is an infection caused by bacteria. When the bacteria invade the body, they produce a toxin, or poison, that causes painful muscle contractions. Tetanus infection mainly affects the neck and abdomen. Tetanus is also called "lockjaw" because it often causes a person's neck and jaw muscles to lock, making it hard to open the mouth or swallow. It can also cause breathing problems, severe muscle spasms, and seizures. Complete recovery can take months. If left untreated, tetanus can be fatal.

Tetanus is different from other vaccine-preventable diseases in that it does not spread from person to person. The bacteria are usually found in soil, dust and manure and enter the body through breaks in the skin – usually cuts or puncture wounds. The bacteria can then produce a toxin that spreads through the body causing the painful symptoms of tetanus. About 3 weeks after exposure, you might get a headache, and have spasms in the jaw muscles. The muscle spasms can be strong enough to break your bones, and you might have to spend several weeks in the hospital under intensive care.

Tetanus Vaccine Protection

Tetanus Vaccines

DTaP: pediatric diphtheria, tetanus, and acellular pertussis (whooping cough) vaccine for children younger than age 7

DT: pediatric diphtheria and tetanus vaccine, used as a substitute for children who cannot tolerate pertussis vaccine

Tdap: tetanus, diphtheria, and acellular pertussis vaccine for older children and adults

Td: tetanus and diphtheria vaccine for older children and adults

The DTaP vaccine (diphtheria, tetanus, and pertussis) is highly effective in preventing tetanus in young children. DTaP shots are recommended for babies at ages 2, 4, and 6 months, and again at 15 through 18 months of age. A DTaP booster is recommended for children ages 4 through 6 years.

Because immunity to tetanus decreases over time, older children need to get the Tdap vaccine. This booster shot contains a full dose of tetanus and lower doses of diphtheria and pertussis (whooping cough). The Tdap vaccine is recommended for all 11 through 18 year olds, preferably given to preteens going to the doctor for a regular check-up at age 11 or 12 years.

Adults need to get a booster shot every 10 years to stay protected since immunity to tetanus decreases over time. For adults who haven't gotten Tdap yet, the easiest thing to do is to get Tdap instead of their next regular tetanus (Td) booster. The dose of Tdap can be given earlier than the 10-year mark, so it's a good idea for adults to talk to a doctor about what's best for their specific situation. Make sure you and your child are protected against tetanus

Heartburn

Heartburn Overview

Heartburn is an uncomfortable but common feeling of burning or warmth in the chest. Although the pain of heartburn is felt in the chest, heartburn has nothing to do with the heart. Instead, heartburn is caused by stomach acid.

Continual bouts of heartburn can be a symptom of a more serious condition called gastroesophageal reflux disease or GERD. Frequent or severe heartburn may limit daily activities and lead to further complications such as ulcers in the esophagus. With proper understanding of heartburn and its treatment, relief can be obtained from this condition.

Heartburn is a common symptom in most people. About one-third of adults experience heartburn. Anywhere from 17%-45% of pregnant women have heartburn or related symptoms.

Heartburn Causes

The food that is swallowed travels from the mouth to the stomach through a hollow tube called the esophagus (or food pipe). Before entering the stomach, food must pass through a tight muscle at the lower end of the esophagus called the lower esophageal sphincter (LES). The lower esophageal sphincter prevents food from traveling backward into the esophagus.

Once in the stomach, stomach acid digests the food. This acid is very strong and the stomach is protected from its own acid by a special mucous layer. The esophagus does not have this special protection. If the lower esophageal sphincter does not close completely, the lower part of the esophagus can be damaged by refluxing stomach acid. When this occurs, heartburn may be experienced.

The lower esophageal sphincter may not close completely allowing stomach acid into the esophagus for these reasons:

• Certain foods and drinks the lower esophageal sphincter. These include chocolate, peppermint, caffeinated beverages (such as coffee, tea, and soft drinks), fatty foods, and alcohol.
• Heartburn often depends on the body's position. It is easier for stomach acid to flow back into the esophagus if a person is lying on the back, on the right side, or bending over.
• Anything that increases the pressure in the abdomen, forcing stomach acid backward into the esophagus, can cause heartburn. Lifting, straining, coughing, tight clothing, obesity, and pregnancy can worsen heartburn.
• People with certain medical conditions have an increased risk of heartburn. These conditions include: hiatal hernia, diabetes, gastroparesis, and many autoimmune diseases (CREST syndrome, Raynaud's phenomenon, and scleroderma).
• Many prescription medications can loosen the lower esophageal sphincter, including blood pressure and heart medications, and the asthma drugtheophylline.
• Many substances directly irritate the lining of the esophagus and contribute to heartburn. These include spicy foods, citrus fruits and juices, tomatoes and tomato sauces, cigarette smoke, aspirin, ibuprofen (Motrin, Advil etc.), and medicine prescribed to treat osteoporosis.

Heartburn Symptoms

Heartburn is a burning feeling in the chest. The sensation may spread up into the throat, jaw, arms, or back. That's why heartburn is often mistaken for chest pain due to a heart attack. However, if a person is having chest pain for any reason, seek medical attention immediately.

Heartburn (often called acid indigestion) typically occurs 30-60 minutes after meals. The pain is worse when lying down, bending forward, and straining to pass stools. The pain is relieved by standing upright, swallowing saliva or water, or by taking antacids.

• If small amounts of stomach acid or food travel beyond the esophagus and up into the mouth, the person may experience bitter a or sour taste (regurgitation). Regurgitation is common after meals, especially if the person is lying down, bending over, or straining.
• Stomach acid can also affect the respiratory tract, causing asthma, hoarseness, chronic cough, sore throat, or tooth damage (acid eats the enamel on teeth). The person may feel as if he or she has a lump in the throat.
• If the acid reflux continues for long periods of time, the esophagus becomes damaged. The person may have difficulty swallowing. In more serious cases, weight loss and dehydration occur. Very rarely, the esophagus may bleed or tear completely because it is so damaged. In severe cases, the person may vomit blood or have small amounts of blood in bowel movements.

When to Seek Medical Care

Call your health care professional if heartburn continues despite lifestyle modifications and use of antacids or low doses of acid blockers. Call a health care professional if a person has heartburn more than three times a week for over 2 weeks. The health care professional will prescribe medications or make other recommendations to help the pain.

Seek emergency medical care. Chronic heartburn can sometimes lead to serious complications that require immediate medical attention. Go to a hospital's emergency department if you have any of the following symptoms:

• Throwing up blood or passing blood in the stools
• Chest pain
• Severe pain, dizziness, or lightheadedness
• Difficulty swallowing
• Shortness of breath
• Dehydration
• Unintentional weight loss

NOTE: The pain of heartburn can often be confused with pain that is actually due to more serious heart problems, such as a heart attack. If you or a family member has a history of heart disease, be aware of this possibility. If pain is accompanied by sweating, nausea, vomiting, difficulty breathing, or worsens with activity, you may need your heart evaluated immediately.

Heartburn Diagnosis

Heartburn may be obvious from the symptoms, so the health care professional may not need to perform any tests or do an extensive exam. The patient may be counseled to make lifestyle modifications and dietary changes to begin immediately.

The doctor may order certain procedures if the diagnosis is unclear or if the prescribed medications are not relieving the patient's heartburn.

Exams and Tests

• The most common procedure is called as gastrointestinal endoscopy(esophagogastroduodenoscopy or EGD). During this procedure the patient is lightly sedated. A special camera is placed through the mouth and into the esophagus and stomach. The doctor can see how much damage has been done to the esophagus from stomach acid. The doctor will be able to determine and possibly treat the complications of heartburn, such as problems swallowing or bleeding. An upper endoscopy assist the doctor in diagnosing other explanations for the pain, such as an infection.
• The patient may undergo an upper GI series. In this test, the patient drinks a liquid that coats the esophagus and stomach and shows up on X-rays that are taken subsequently.
• If an upper endoscopy shows everything is normal but the patient continues to have pain, the doctor may do further testing to clarify the diagnosis. This includes a procedure to measure the weakness of the LES muscle, called as esophageal manometry.
• The 24-hour pH monitoring test measures the strength of stomach acid. A very thin tube is passed through nose into the patient's esophagus. For the next 24 hours, the test measures the amount of acid reflux that occurs while the patient goes about his or her regular activities, including eating.
• Another test uses a tiny capsule to measure acid reflux levels. The doctor uses an endoscope to attach the bean-sized capsule to the patient's esophagus. It measures pH levels and delivers readings by radio wave to a receiver the patient wears on the belt. After about 48 hours, the capsule detaches and passes through the digestive system and is not recovered.

If the patient's health care professional feels the patient is at risk for heart problems, additional tests may be performed to make sure the patient's heart is healthy.

Heartburn Treatment

Antacids, acid blockers, and perhaps surgery may provide relief from heartburn and prevent it from turning into more serious disease.

Heartburn Foods and Remedies

For mild or occasional symptoms, simple lifestyle modifications can help provide relief of symptoms.

• Avoid large meals.
• Avoid caffeine (coffee, teas, soft drinks).
• Avoid foods or drinks that reduce pressure on the lower esophageal sphincter such as chocolate, peppermint, caffeine-containing beverages, alcohol, and fatty or fried foods.
• Avoid foods that damage the esophagus such as spicy foods, citrus fruits and juices, tomatoes and tomato sauces.
• After eating, beware of activities that force acid back into the esophagus. Such activities include lifting, straining, coughing, and wearing tight clothing.
• Use gravity to your advantage. Avoid lying down within 3 hours of meals. If you suffer from nighttime heartburn, elevate the head of your bed when sleeping. Place 6-inch blocks underneath the head of the bed, or place a wedge under the mattress. Simply using more pillows under your head will not help and may worsen heartburn by increasing pressure on the stomach.
• Lose weight if you are overweight.
• Stop smoking.
• Limit alcohol intake.
• Antacids such as Maalox, Mylanta, Tums, or Rolaids can also provide relief. Antacids work by neutralizing acid. They should be taken 1 hour after meals or when heartburn symptoms occur.
• Low doses of drugs that block the production of stomach acid are available over-the-counter including cimetidine (Tagamet), ranitidine (Zintac), and famotidine (Topcid).

Heartburn Medical Treatment

The health care professional will recommend treating heartburn in a gradual progression.

Over-the-counter antacids are the oldest effective self-treatments for heartburn. Through the centuries, people have chewed on chalk (the active ingredient is calcium carbonate) to ease heartburn. Tablets are less powerful in neutralizing stomach acid than liquid antacids.

• Antacids are useful because they provide rapid, but temporary relief of heartburn, especially if it is caused by foods or certain activity. Over-the-counter (OTC) antacids do not prevent heartburn from returning or allow a patient's injured esophagus to heal. If the patient need antacids for more than two weeks, talk to a your health care professional to have your condition reviewed and receive appropriate treatment.
• Most varieties of antacids you can buy in drug stores are combinations of aluminumand magnesium hydroxide. Antacids containing these ingredients may produce unwanted diarrhea or constipation. Discuss these medications with your doctor before use if you have any history of kidney (renal) disease.
• Antacids containing calcium carbonate are the most potent in neutralizing stomach acid. Popular brands includes Digene Gel, Gelusil Gel etc

Follow label instructions and do not take more than the recommended daily dose. Most commonly, patients take antacids after meals and at bedtime, or when they have symptoms.

Always tell a health care professional about your antacid use.

Heartburn Medications

If the patient still has heartburn symptoms after lifestyle modifications and use of antacids, the health care professional may prescribe drugs.

• Histamine-2 blockers decrease the amount of acid the stomach produces. Examples include ranitidine (Zintac), cimetidine(Tagamet), famotidine (Topcid), and nizatidine (Axid). Many of these drugs can be purchased over-the-counter at lower doses, but patients will need a doctor's prescription for higher doses. They provide relief of symptoms within 30 minutes and are taken twice a day.
• If heartburn persists, the doctor may recommend adding a drug such as metoclopramide (Perinorm). Thisf drug empties food and acid quickly from the stomach so less acid can reflux back into the esophagus. Reglan/Perinorm also helps tighten the LES muscle.
• If the patient still has symptoms, the doctor will then recommend drugs called proton pump inhibitors. Examples of these drugs include omeprazole (Ocid), lansoprazole(Lanzol),Rabeprazole (Razo) esomeprazole (Nexium), and pantoprazole (Pantop). These compounds prevent the stomach from secreting acid. They are very effective and are typically taken once a day. These drugs are usually only prescribed if other drugs have not helped the symptoms. Many of these drugs can be bought OTC at lower doses, however, a doctor's prescription is required for higher doses.

Heartburn Surgery

If prescription drugs are not relieving heartburn, or if the patient has serious complications of heartburn, surgery may be required. The surgery is called fundoplication. Its purpose is to tighten the lower esophageal sphincter muscle. The stomach is repositioned in such a way as to prevent acid from flowing backward into the esophagus. This surgery is successful in 70%-95% of people, depending on the severity of the disease. Laparoscopic fundoplication tends to yield better results than invasive surgery.

Heartburn Prevention

Many cases of heartburn can be prevented by simple lifestyle modifications in diet, activity, and habits. Watching what kinds of foods you eat and how much you eat can influence symptoms. Pay attention to body position after eating. Don't lie down soon after a meal. Limit alcohol intake, quit smoking, and lose weight to improve not only heartburn symptoms but also your overall health.

Heartburn Prognosis

Most cases of heartburn are treated effectively with lifestyle modifications, antacids, or prescription drugs. Relapse is common when treatment is stopped. Other possible problems caused by acid reflux include inflammation of the throat, voice box, and airways. Serious complications, such as bleeding or difficulty swallowing, are rare. A complication of chronic heartburn and inflammation of the esophagus is called Barrett's esophagus. If left untreated for years, chronic heartburn can in rare cases lead to cancer of the esophagus.

Heat-Related Illnesses (Heat Cramps, Heat Exhaustion, Heat Stroke)

What are heat-related illnesses?

Exposure to abnormal or prolonged amounts of heat and humidity without relief or adequate fluid intake can cause various types of heat-related illness. Children and adolescents adjust more slowly than adults do to changes in environmental heat. They also produce more heat with activity than adults, and sweat less. Sweating is one of the body's normal cooling mechanisms. Children and adolescents often do not think to rest when having fun and may not drink enough fluids when playing, exercising, or participating in sports.

Children and adolescents with chronic health problems, or those who take certain medicines, may be more susceptible to heat-related illnesses. Children and adolescents who are overweight or wear heavy clothing during exertion, such as marching band or football uniforms, are also more susceptible.

There are three types of heat-related illnesses:

• Heat cramps
• Heat exhaustion
• Heat stroke

What are heat cramps?

Heat cramps are the mildest form of heat injury and consist of painful muscle cramps and spasms that occur during or after intense exercise and sweating in high heat.

What is heat exhaustion?

Heat exhaustion is more severe than heat cramps and results from a loss of water and salt in the body. It occurs in conditions of extreme heat and excessive sweating without adequate fluid and salt replacement. Heat exhaustion occurs when the body is unable to cool itself properly and, if left untreated, can progress to heat stroke.

What is heat stroke?

Heat stroke, the most severe form of heat illness, occurs when the body's heat-regulating system is overwhelmed by excessive heat. It is a life-threatening emergency and requires immediate medical attention.

Symptoms and first-aid measures for heat injuries

Heat cramps

• Painful cramps, especially in the legs
• Flushed, moist skin
  
  
  First Aid

• Move to a cool place and rest.
• Remove excess clothing and place cool cloths on skin; fan skin.
• Give cool sports drinks containing salt and sugar such as Gatorade®.
• Stretch cramped muscles slowly and gently.

Heat exhaustion

• Muscle cramps
• Pale, moist skin
• Usually has a fever over 100.4º F
• Nausea
• Vomiting
• Diarrhea
• Headache
• Fatigue
• Weakness
• Anxiety, and faint feeling
  
  
  First Aid

• Move to a cool place and rest.
• Remove excess clothing and place cool cloths on skin; fan skin.
• Give cool sports drinks containing salt and sugar such as Gatorade®.
• If no improvement or unable to take fluids, call your adolescent's physician or take your child to an emergency department immediately. IV (intravenous) fluids may be needed.

Heat stroke

• Warm, dry skin
• high fever, usually over 104º F
• Rapid heart rate
• Loss of appetite
• Nausea
• Vomiting
• Headache
• Fatigue
• Confusion
• Agitation
• Lethargy
• Stupor
• Seizures, coma, and death are possible
  
  
  First Aid

• Move to a cool place and rest.
• Heat stroke is a life-threatening medical emergency and needs to be treated by a physician.
• Remove excess clothing and drench skin with cool water; fan skin.
• Place ice bags on the armpits and groin areas.
• Offer cool fluids if alert and able to drink.

How can heat stroke be prevented?

Some general guidelines to help protect your adolescent from heat-related illnesses include the following:

• Drink plenty of fluids during vigorous or outdoor activities (including sunbathing), especially on hot days. Drinks of choice include water and sports drinks; avoid alcohol and fluids with caffeine such as tea, coffee, and cola, as these can lead to dehydration.
• Make sure your adolescent dresses in light colored, lightweight, tightly-woven, loose-fitting clothing on hot days.
• Schedule vigorous activity and sports for cooler times of the day. Take rest periods in shady or cool areas.
• Makes sure your adolescent is protected from the sun and wears a hat and sunglasses, and uses an umbrella. Use a sunscreen that is at least SPF (sun protection factor) 15.
• Increase time spent outdoors gradually to get your adolescent's body used to the heat.
• Teach adolescents to take frequent drink breaks and "wet down" or mist themselves with a spray bottle to avoid becoming overheated.
• Try to spend as much time indoors as possible on very hot and humid days.
• Teach your adolescent to warm-up and cool-down before and after exercising.
• If your adolescent has a medical condition or is taking medication, consult your adolescent's physician for further advice for preventing heat-related illnesses.