Hemodynamic changes and intra vascular hydration state in heat stroke

ABSTRACT

Acute and serial hemodynamic measurements in 13 pilgrims [average age, 55.2 +/- SD 9.3 years] suffering from heat stroke [average rectal temperature, 41.3 +/- 1.0°C] revealed a hyperdynamic circulation pattern and a low total peripheral resistance. Five patients had pulmonary edema with an average cardiac index of 5.29 +/- SD 0.56L/min/m2, which was slightly higher than the average cardiac index in the group of eight patients without pulmonary edema, 4.76 +/- SD 0.6L/min/m2. This higher cardiac index was believed to be iatrogenic fluid overload which was hard to accommodate intravascularly with the cooling photogenic fluid overload which was hard to accommodate intravascularly r with the cooling process raising the peripheral vascular resistance, decreasing the venous capacitance, and redistributing the blood from the dilated circulatory bed in the skin to the central circulation. Our data highlight the fact that there is no major intravascular dehydration in heat stroke. The treatment of choice is cooling. The entire process of "supporting the cardiovascular system" should take into consideration avoidance of fluid overload by rapid intravenous fluid administration. Gradual hydration, allowing tie for intracellular compartment repletion after cooling, is more appropriate