Heat stroke in a child

Thermal shock in a child is a condition that develops as a result of a pronounced violation of heat transfer processes due to unfavorable environmental conditions (high temperature and humidity) and is characterized by an extreme degree of body overheating with a violation of the functions of the central nervous system, cardiovascular system and severe water-electrolyte disorders.

[1], [2]

Epidemiology of heat stroke in children

Children with CNS diseases, as well as those with CCT, with pathology of the endocrine system and other conditions characterized by a violation of thermoregulatory mechanisms are more likely to suffer a thermal shock.

[3], [4], [5], [6], [7]

How does heat stroke develop in children?

Depending on the mechanism of development, several pathogenetic forms of heat stroke are distinguished.

Pathogenetic variants of heat stroke:

• A water-deficient variant develops when the child does not receive a sufficient amount of liquid.
• Hyponatremic variant occurs when an abundant sweating child receives a sufficient amount of fresh water in conditions of alimentary deficiency of salts. Signs of CNS damage are caused by the increasing hypotonic edema of the brain.

Hyperthermia leads to disruption of the functions of all organs and systems. There is a decrease in CB, tachycardia and hypotension develop, tissue perfusion is sharply reduced. Hypovolemia, decreased BCC and kidney damage lead to the development of oliguria or anuria and acute tubular necrosis. Damage to the kidneys can be exacerbated by the development of acute rhabdomyolysis.

Symptoms of a child's heat stroke

The clinical picture depends on the pathogenetic variant of heat stroke.

Water-Deficit Heat Shock Option

In the clinical picture, a strong thirst is prevailing. The child becomes sluggish, in some cases there are delusions and hallucinations.

Hyponatremic variant of heat stroke

An early clinical sign for this form of the disease is painful spasms of the muscles of the extremities. At the same time there is no thirst. Later the child becomes restless, excitable, complains of a headache, nausea and vomiting may occur. Further, depression of consciousness (up to coma) develops, there is a danger of respiratory depression and cardiovascular system activity.

Differential-diagnostic measures

Diagnosis of heat stroke in a child usually does not cause difficulties. However, given that a severe condition can not develop immediately, and 4-6 hours after the child's stay in unfavorable conditions, it is necessary to collect anamnestic data. Clarify the duration of temperature increase, fluid intake, diuresis, the presence of predisposing factors and concomitant diseases.

At a primary examination of the patient first of all, it is necessary to assess the level of consciousness, the effectiveness of independent breathing and hemodynamic parameters. Any violations of vital functions are indications for the urgent hospitalization of a child in the intensive care unit.

Water-Deficit Heat Shock Option

Sweating and diuresis are reduced, mucous dry. Body temperature rises rapidly. For this form of heat stroke is characterized by a tremor of the extremities, and in the later period there may be convulsions.

[8], [9], [10], [11], [12], [13], [14],

Hyponatremic variant

Sweating is not broken, and body temperature can be increased slightly.

Treatment of heat stroke in children

At elevated temperature, the body begins to use physical methods of cooling (the baby is undressed, ice packs are applied to the head, neck, on the groin area, the skin is moistened and blown by the fan).

Water-Deficiency Heatstroke

If the patient is conscious, give an abundant slightly salty drink. Infusion therapy is performed in the treatment of hypertensive dehydration.

Basic principles of treatment:

• The initial infusion involves predominantly isotonic or hypotonic saline solutions.
• Given that the osmolality of the plasma with such a mechanism of heat stroke is sharply increased, the introduction of colloidal solutions should be avoided.
• From the introduction of glucose solutions, it is necessary to abstain until the blood glucose level is normalized.
• The total infusion volume can be 50-60 ml / (kghsut) and higher.
• When convulsions are prescribed anticonvulsant therapy, it is preferable to use benzodiazepines.

Hyponatremic heat stroke

With an isolated sodium deficiency, infusion of 0.9% and hypertonic sodium chloride solutions should be performed at a rate of 2 g of dry residue per 1 kg of body weight per day under the control of serum sodium concentration. Infusion therapy is performed before clinical improvement (recovery of consciousness, reduction of hyperthermia, normalization of blood pressure and diuresis).

With violations of breathing, hemodynamics and neurologic symptoms, oxygen therapy is prescribed, according to indications - IVL.