{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T19:50:28Z","timestamp":1759693828460,"version":"3.43.0"},"reference-count":17,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J R Army Med Corps"],"published-print":{"date-parts":[[2005,3]]},"abstract":"\n \n During operations in subtropical areas over the summer months of 2001 and 2003 the authors audited 80 patients with heat-related illness, with the intention of defining the nature and distribution of the underlying pathophysiology. Haematological, biochemical and clinical data were gathered prospectively and patients allocated to diagnostic categories on the basis of the combination of clinical findings and investigations. Four basic types of heatrelated illness could be distinguished: (1) excessive salt loss with hyponatraemic dehydration, (2) hypokalaemic alkalosis with low serum bicarbonate, (3) haemodilution associated with excessive water intake in stressed individuals, and (4) loss of normal thermoregulation, characterised by high core temperature and paradoxical cessation of sweating. Most of the patients fell clearly into a single distinct category, but there was a degree of overlap. Reduction of extracellular fluid volume was a common central mechanism. Common provoking factors identified were: gastrointestinal upset, history of previous heat intolerance (35%) environmental temperatures exceeding 45\u00b0C, short period of acclimatisation (55%), travel, sleep loss, hard physical work especially if directly preceded by a period of sleep, work in confined humid spaces (45%), and lack of additional salt intake. When several of these factors were present together admission rate over one 24-hour period reached 3% of persons at risk per day. Patients are often more ill than they appear. To reduce the incidence of heat illness during future operations the following measures are proposed:<\/jats:p>\n \n \n \n Avoidance of physical exertion during the heat of the day for the first 7-10 days.<\/jats:italic>\n <\/jats:p>\n <\/jats:list-item>\n \n \n Progressive gentle exercise in the early morning or late evening over the same period.<\/jats:italic>\n <\/jats:p>\n <\/jats:list-item>\n \n \n Increase in daily salt intake to 15-20gm for the first 2-3 weeks.<\/jats:italic>\n <\/jats:p>\n <\/jats:list-item>\n \n \n Only sufficient water intake to relieve thirst and to ensure the flow of abundant dilute urine.<\/jats:italic>\n <\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1136\/jramc-151-01-03","type":"journal-article","created":{"date-parts":[[2013,3,19]],"date-time":"2013-03-19T19:43:32Z","timestamp":1363722212000},"page":"11-18","source":"Crossref","is-referenced-by-count":7,"title":["An Observational Study On The Spectrum Of Heat-Related Illness, With A Proposal On Classification"],"prefix":"10.1136","volume":"151","author":[{"given":"T K","family":"Day","sequence":"first","affiliation":[{"name":"TPMH, RAF Akrotiri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Grimshaw","sequence":"additional","affiliation":[{"name":"612 Sqn RAF Leuchars Fife"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2005,3,1]]},"reference":[{"key":"ref_1","first-page":"3","article-title":"Exertional heat stroke - history and epidemiology: definitions and groups at risk","volume-title":"hypermetabolic disorders","author":"Dickinson, J.G.","year":"1996","unstructured":"Dickinson JG. Exertional heat stroke - history and epidemiology: definitions and groups at risk. In: Hopkins PM Ellis FR eds. Hyperthermic and hypermetabolic disorders. Cambridge: Cambridge University Press 1996; 3-19."},{"key":"ref_2","article-title":"Climatic injuries in the armed forces: prevention and treatment","author":"Services, Defence Medical","year":"2003","unstructured":"Defence Medical Services. Climatic injuries in the armed forces: prevention and treatment. Joint Services Publication 539, Jan 2003."},{"issue":"30","key":"ref_3","first-page":"708","article-title":"Influence of acclimation on sweat sodium concentration","volume":"1971","author":"CG, Allan JR Wilson","unstructured":"Allan JR Wilson CG. Influence of acclimation on sweat sodium concentration. J Appl Physiol 1971: 30(5): 708-12.","journal-title":"J Appl Physiol"},{"key":"ref_4","article-title":"Heat Stress and Heat Related Disorders","author":"Leithead, C.S.","year":"1964","unstructured":"Leithead CS. Heat Stress and Heat Related Disorders. Cassell, London 1964."},{"issue":"6","key":"ref_5","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.1152\/jappl.1981.51.6.1594","article-title":"Effect of blood volume on sweating rate and body fluids in humans","volume":"51","author":"Fortney, S.M.; Nadel, E.R.; Wenger, C.B.","year":"1981","unstructured":"Fortney SM, Nadel ER,Wenger CB, et al. Effect of blood volume on sweating rate and body fluids in humans. J Appl Physiol 1981; 51(6): 1594-600.","journal-title":"J Appl Physiol"},{"issue":"61","key":"ref_6","first-page":"967","article-title":"Plasma aldosterone and sweat sodium concentration after exercise and heat acclimation","volume":"1986","author":"Kirkby, C.R.; Convertino, V.A.","unstructured":"Kirkby CR, Convertino VA. Plasma aldosterone and sweat sodium concentration after exercise and heat acclimation. J Appl Physiol 1986: 61(3): 967-70.","journal-title":"J Appl Physiol"},{"issue":"10","key":"ref_7","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1002\/clc.4960111010","article-title":"Differences in composition of sweat produced by thermal exposure and by running exercise","volume":"11","author":"Fukumoto, T.; Tanaka, T.; Fujaka, H.","year":"1988","unstructured":"Fukumoto T,Tanaka T, Fujaka H, et al. Differences in composition of sweat produced by thermal exposure and by running exercise. Clin Cardiol 1988; 11(10): 707-9.","journal-title":"Clin Cardiol"},{"issue":"1","key":"ref_8","first-page":"36","article-title":"Time course of recovery and heat acclimation ability of prior exertional heat stroke patients","volume":"22","author":"Armstrong, L.E.; DeLuca, J.P.; Hubbard, R.W.","year":"1990","unstructured":"Armstrong LE, DeLuca JP, Hubbard RW. Time course of recovery and heat acclimation ability of prior exertional heat stroke patients. Med Sci Sports Exerc 1990; 22(1): 36-48.","journal-title":"Med Sci Sports Exerc"},{"issue":"3","key":"ref_9","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1152\/jappl.1997.83.3.860","article-title":"Hyperhydration: thermoregulatory effects during compensable exercise heat-stress","volume":"83","author":"Latzka, W.A.; Shenka, M.N.; Montain, S.J.","year":"1997","unstructured":"Latzka WA, Shenka MN, Montain SJ, et al. Hyperhydration: thermoregulatory effects during compensable exercise heat-stress. J App Physiol 1997; 83(3): 860-6.","journal-title":"J App Physiol"},{"issue":"3","key":"ref_10","first-page":"370","article-title":"Water intoxication: a possible complication during endurance exercise","volume":"17","author":"Noakes, T.D.; Goodwin, N.; Rayner, B.L.","year":"1985","unstructured":"Noakes TD, Goodwin N, Rayner BL. Water intoxication: a possible complication during endurance exercise. Med Sci Sports Exerc 1985; 17(3): 370-5.","journal-title":"Med Sci Sports Exerc"},{"issue":"10","key":"ref_11","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/S0899-9007(00)00412-3","volume":"16","author":"Stricker, E.M.; Sved, A.F.","year":"2000","unstructured":"Stricker EM, Sved AF. Thirst. Nutrition 2000; 16(10): 821-6.","journal-title":"Thirst. Nutrition"},{"issue":"2","key":"ref_12","first-page":"143","article-title":"Changes in body water and electrolytes during heat acclimation: effects of dietary sodium","volume":"58","author":"Armstrong, L.E.; Costill, D.L.; Fink, W.J.","year":"1987","unstructured":"Armstrong LE, Costill DL, Fink WJ. Changes in body water and electrolytes during heat acclimation: effects of dietary sodium. Aviat Space Environ Med 1987; 58(2): 143-8.","journal-title":"Aviat Space Environ Med"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/BF01711537","article-title":"Heatstroke: a new look at an ancient disease","volume":"21","author":"Bouchama, A.","year":"1995","unstructured":"Bouchama A. Heatstroke: a new look at an ancient disease. Intensive Care Med 1995; 21: 623-5.","journal-title":"Intensive Care Med"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1023\/A:1006070708952","article-title":"Echocardiographic and Doppler studies of patients with heat stroke and heat exhaustion","volume":"15","author":"Shahid, M.S.; Hatle, L.; Mansour, H.","year":"1999","unstructured":"Shahid MS, Hatle L, Mansour H, et al. Echocardiographic and Doppler studies of patients with heat stroke and heat exhaustion. Int J Cardiac Imaging 1999; 15: 279-85.","journal-title":"Int J Cardiac Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"173","DOI":"10.7326\/0003-4819-129-3-199808010-00001","article-title":"Nearfatal heat stroke during the 1995 heat wave in Chicago","volume":"129","author":"Dermatte, J.E.; O\u00edMara, K.; Buescher, J.","year":"1998","unstructured":"Dermatte JE, O\u00edMara K, Buescher J et al. Nearfatal heat stroke during the 1995 heat wave in Chicago. Ann Int Med 1998; 129: 173-81.","journal-title":"Ann Int Med"},{"issue":"5","key":"ref_16","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1093\/bja\/88.5.700","article-title":"Heat stroke: implications for critical care and anaesthesia","volume":"88","author":"Grogan, H.; Hopkins, P.M.","year":"2002","unstructured":"Grogan H, Hopkins PM. Heat stroke: implications for critical care and anaesthesia. Brit J Anaesth 2002; 88(5): 700-7.","journal-title":"Brit J Anaesth"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1093\/clinchem\/43.7.1182","article-title":"Serum enzymes in heat stroke: prognostic implication","volume":"43","author":"Alzeer, A.H.; El-Hazmi, M.A.F.; Warsy, A.S.","year":"1997","unstructured":"Alzeer AH, El-Hazmi MAF,Warsy AS, et al. Serum enzymes in heat stroke: prognostic implication. Clin Chem 1997; 43: 1182-7.","journal-title":"Clin Chem"}],"container-title":["Journal of the Royal Army Medical Corps"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jramc-151-01-03","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T21:57:23Z","timestamp":1755122243000},"score":1,"resource":{"primary":{"URL":"https:\/\/militaryhealth.bmj.com\/lookup\/doi\/10.1136\/jramc-151-01-03"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,3]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2005,3,1]]},"published-print":{"date-parts":[[2005,3]]}},"alternative-id":["10.1136\/jramc-151-01-03"],"URL":"https:\/\/doi.org\/10.1136\/jramc-151-01-03","relation":{},"ISSN":["0035-8665","2052-0468"],"issn-type":[{"type":"print","value":"0035-8665"},{"type":"electronic","value":"2052-0468"}],"subject":[],"published":{"date-parts":[[2005,3]]}}}