It is also known as Heat stroke or Heat hyperpyrexia. Very often in summers there are news in daily papers about the deaths occuring because of heat stroke. But rarely people think about this cause of death and that what it is? Why it affects and how it affects? And what measures can be taken to prevent it, and what should be done after sunstroke. This all I would like to discuss here. So that all the cases of sunstroke should not prove fatal.
Homoeopathy offers few very good remedies to tackle this yearly problem. Sunstroke is quite common in India’s tropics, though white race is more susceptible. In places like Calcutta, Rajasthan, Bihar and Delhi this problem seen quite often.
Sunstroke is most common in elderly people with pre-existing chronic diseases like Arteriosclerosis, Congestive heart failure. It is also more common in patients those who are taking diuretics. Predisposing factors can include Diabetes Mellitus, Alcoholism, use of drugs like Atropine and skin disorders in which it may be difficult to loose heat such as Ectodermal Dysplasia, Congenital absence of Sweat glands, or severe Scleroderma.
Direct exposure to sun is not a necessary prerequisite. Heat hyperpyrexia may develop during any period of hot weather, but the incidence in temperate climate increases during prolonged heat waves and at temperature of 90 F (32.2 C) or higher. High humidity in the range of 60-75% is a prerequisite to heat stroke.
Sweat fatigue is the major pathogenic mechanism of heat stroke and patients stop sweating before the onset of acute symptoms. The cessation of sweating is due to an intrinsic breakdown of the heat regulatory mechanism for reason not known. As manifestations there may be few premonitory symptoms of heat stroke and loss of the consciousness may be the first sign. Few patients may complain of headache, vertigo, faintness, abdominal distress, confusion, hyperaemia, delirium develop in more severe cases.
Fever and prostration are the significant findings on physical examination. Rectal temperature greater than 106F (41.1 C) is common and a grave prognostic sign. Maximum internal body temperature as high 112-113 F (44.4 C) have been recorded. The skin is hot and dry and sweating is absent .The pulse rate is increased and the respiration or breathing is rapid and weak. Systolic blood pressure may be elevated, muscles are flaccid and tendon reflexes may be diminished. Lethargy, stupor or coma depending on the severity, is present. Shock is common in fatal cases
Urine and blood examination show few abnormalities. Increase in W.B.C. count is characteristic as are Proteinuria, and elevation in BUN. Respiratory Alkalosis Hypokalemia, Hypophosphatemia may be seen. In addition to tachycardia or fast pulse rate E.C.G. may show sinus Arrhythmia, flattening and subsequent inversion of T wave and depression of the ST segment, diffuse myocardial necrosis with E.C.G. evidence of Myocardial Infarction has been reported. Other major laboratory abnormalities include Thrombocytopenia and prolonged bleeding, clotting and prothrombin times, Afibrinogenemia and Fibrinolysis and consumptive coagulopathy. All these may be responsible for diffused bleeding. Liver damage is common, it appears within 24-36 hours, and is characterised by clinically apparent Jaundice and often by abnormalities in Hepatocellular enzymes. Renal failure is a very common complication of Sunstroke.
Person with sunstroke may die within few hours after being discovered, or may die of the complications such as Acute renal failure. However number of patients may die several weeks after the acute episode, usually of Myocardial Infarction, Heat failure, Renal failure, Bronchopneumonia or complicated Bacteraemia. Death may rapidly ensue complications include dilatation of the Right heart and Oedema of the lungs. If the patient recovers from the coma there may be mental confusion, Aphasia, Incontinence, and signs of Pyramidal or cerebellar lesion. Complete recovery may ensue, or the patient may show the sign of Dementia. The prophylaxis would be, the bowels should be kept open daily. Plenty of fluids taken, but Alcohol should not be consumed in excess. The head, neck and spinal cord should be adequately protected from the sun.
Sunstroke require heroic emergency measures. Time is most important; patient should be placed in a cool place with adequate circulation of fresh air with most of the clothings removed. As the pathogenesis of the heat stroke involves failure of the Heat – regulating mechanism with cessation of sweating, external means of dissipation must be employed. The most effective measure is to immerse the patient in the ice water bath; there is no substitute for this seemingly drastic treatment. An ice water bath does not induce shock or stimulate significant cutaneous vasoconstriction. Bath should be given with minimum of delay. Patient should constantly be watched and the rectal temperature should be monitored. Bath may be discontinued once the rectal temperature falls below 101F(38.3 C) but the treatment should be resumed if there is a febrile rebound. As compared with immersion in ice wate4, other forms of therapy are less effective, but covering the patient with cold wet towels under a fan may be satisfactory, if a bath is not available. After the bath patient should be placed in a cold well ventilated room. Massage of the skin aids the acceleration of heat loss and stimulates the return of cool peripheral blood in the overheated brain and viscera.
Stimulants such as narcotics are contraindicated. Intravenous fluids should be given with the monitoring of central venous pressure and urinary output. Both dehydration and heart failure be avoided. Fresh blood may be given in cases of bleeding. Persistent oliguria is an indication of early Dialysis.
Blood film must be taken to exclude Malaria. Homoeopathically most important remedies are Glonoine, Aco, Bell, Camphor, Verat V, Stram, and Nat Mur etc. with definite indications of the remedy.
In young children convulsions are common at temperature higher than 106 F, and irreversible brain damage due to protein duration is common in temperature of 108 F. Fortunately when fever reaches the dangerous level the mechanism of heat loss is suddenly activated, consequently oral temperature above 106 F are not very commonly seen.
The systemic symptoms accompanying deviation in temperature are not understood very rightly. For example at temperature of 102 F many patients have malaise and drowsiness, weakness and generalised aches and pains, many other however feel entirely well. Though homoeopathically it individualizes a patient from the other and we have certain remedies working beautifully in these cases also e.g. Opium, Bell, Arnica, Bapt, R.T, Ars Alb, Aco, and Gels etc.
Why some individuals are able to tolerate fever so well while others become markedly ill remains an enigma.
1) GLONOINE: The chief remedy with top ranking in Kent’s Repertory. It is an excellent remedy for Heat Stroke. It should be given immediately on the attack. Severe throbbing headaches and bursting pains, with pale face, fixed eyes, white tongue, full round pulse, labored respiration, cerebral vomiting and sinking at the pit of stomach, unconsciousness, limbs relaxed, tremors, jerks involuntary evacuations. High temperature. Give in 3 potency every 5 minutes at first, the intervals being gradually increased. For the after effects of Heat Stroke it may be given every 4 hourly.
2) ACONITE: Our old known friendly remedy Aconite, with all the acute stages of any condition, we think of it.
3) BELLADONNA: Headache with face flushed and hot, drowsiness, loss of consciousness, perspiration may be on covered parts whistling in the ears and constriction of the cheat. Also complaints from having slept in sun.
4) GELSEMIUM: Giddiness as of intoxicated on trying to move, dull, dizzy and drowsy bend like pain, occipital headache, vertigo spreading from the occiput headache preceded by the blindness > by profuse urination.
5) THERIDION: Orange spider. Vertigo, sick headache, peculiar pain around heart region. Sensitive to noise, it penetrates the body specially teeth. Foam at mouth with shaking chill. Easily excited.
6) ARGENTUM NITRICUM: Chills with nausea, chilly when uncovered yet smothers when covered. Nervous headache, with coldness and trembling.
7) CAMPHOR: Pulse small, weak, slow congestive chill. Tongue cold, flabby, trembling. Wants covers during the hot stage, sudden inflammatory fevers with rapid alternation of heat and cold followed by rapid perspiration. Heat or sweat better by covering. Chilly below scapular region. Fleeting pains with stitches in the temples and orbits. Head is drawn to one side.
8) STRAMONIUM: Vertigo worse walking in the dark or with eyes closed. Jerks head up from pillow and drops it again, during unconsciousness, headache with tendency to speak incoherently. Head bent backward. Dribbling of viscid saliva, violent fever, and cold sweat during spasms.
9) VERATRUM VIRIDE: Vertigo with nausea and sudden prostration > closing eyes and resting head, throbs on rising up. Intense congestion almost Apoplectic. Head hot, blood shot eyes, bloated livid face, pupils dilated. Hyperaemia in the evening and hypothermia in the mornings. Hyperpyrexia or rapidly oscillating temperature, cerebrospinal, suppurative acute type of fever. Tongue white as if bleached dry with red streak down centre.
10) LACHESIS: When the Sun’s heat makes the patient dizzy and faint. Hot water greatly fatigues. Hot flushes and hot perspiration. Chill eating meals. Headaches from strong smells.
12) OPIUM: Face bloated, breathing difficult or obstructed, vertigo after fright of old people with lightness of head, heavy occiput, paralysis of brain, head hot with hot sweat, pulse full and slow, heat extending over body. Fever is characterized by stupor, snoring respiration, twitching of limbs intense thirst and sleepiness.
13) NATRUM MURIATICUM: Chronic effects of Sun Stoke with headache returning in hot weather. Debility and headache by sun heat, Vertigo as if falling. Bursting maddening, hammering headaches over eyes and vertex< awakening and from sunrise to sunset. It works wonderfully in 30th potency if given at 4 hourly intervals.