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Features and Outcomes of Classic Heat Stroke
- I. Maurice Ndukwu, MD, MPH;
- Jane E. Dematte, MD; and
- Karen O'Mara, DO
- University of Chicago; Chicago, IL 60637 (Ndukwu) Michael Reese Hospital and Medical Center; Chicago, IL 60521 (Dematte) Resurrection Medical Center; Chicago, IL 60631 (O'Mara)
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IN RESPONSE:
We appreciate these comments and the opportunity to respond. Although we agree with some of the comments of Drs. Ayus and Arieff, we do not believe that disturbances in serum sodium levels were responsible for the neurologic impairment in our patients. Serum sodium levels at admission were not substantially abnormal in our patients. In addition, sodium values at admission did not differ among patients with minimal or no impairment and those with moderate to severe impairment at discharge.
We agree with Dr. Bouchama that the role of infection in the pathogenesis of heat stroke remains to be elucidated. We believe that the increased incidence of infection seen in our patients is real. Similar to Dr. Bouchama's study, our study included only the results of cultures drawn within the first 24 hours of admission. We believe that our patient sample may have been dissimilar enough from Dr. Bouchama's to explain the differences between his results and ours. The premorbid condition of his patients allowed travel and pilgrimage; this suggests that they were healthier than our patients.
In addition, Dr. Bouchama's patients were in a setting where their heat stroke would be immediately recognized and brought to medical attention. Many of our patients had a significant delay in presenting to the health care system. We do believe our findings warrant further evaluation of the role of infection in future studies.
We thank Drs. Graham and Slovis for their comments about approaches to cooling victims of classic heat stroke. The most effective means of cooling remains controversial. We recommended either cold- or ice-water immersion (conduction) or use of a body cooling unit (evaporation and convection). Body cooling units can be improvised in an emergency department if a shower spray and fan are available and the ambient temperature in the emergency department is appropriately cool. Reported rates for cooling, however, are still highest with immersion (1-4), and the theoretical concerns noted by Dr. Slovis have not been shown to occur in actual practice (5).
Jane E. Dematte, MD
Michael Reese Hospital and Medical Center; Chicago, IL 60521
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
