Heat stroke and heat exhaustion among pilgrims: common signs and symptoms, laboratory profile and methods of managements

Abstract

Background: In the last few years, Hajj season is characterized by high temperature reached up to 46°C.Exposure to great hot environment accompanied with fatigue may result in different heat-related illnesses including heat cramps, heat exhaustion and heat stroke. Objectives: To investigate the types, symptoms, signs, laboratory parameters, associated chronic disease and medical management of heat illness experienced by pilgrims in the fields and emergency centers. Subjects and methods: It is an analytical cross sectional study conducted during Hajj season (2017-2018) including all patients exposed or attended the emergency departments or centers of management heat related medical problems in Ministry of Defense hospitals and centers in Makkah city, Kingdom of Saudi Arabia. A prepared checklist was used to collect data about demographic characteristics of patients, associated risk factors, signs and symptoms as well as data about managements of heat stroke and heat exhaustions. Results: The study included 73 patients diagnosed with either heat exhaustion (52; 71.2%) or heat stroke (21; 28.8%). Their age ranged between 30 and 80 years (57.8±12.7). Males represent 57.5% of them. History of vaccination against seasonal influenza and meningitis was observed among 60% of them.Majority of the patients (74%) exposed to heat for 2-4 hours. The most frequent encountered symptoms were headache (82.2%), extreme weakness (80.8%), and dizziness/vertigo (78.1%). Their body temperature ranged between 31.6-41.2 ˚C (37.4±1.7).Glasgow coma scale ranged between 10 and 15 (14.5±1.2). Dry tongue, sunken eyes, skin rash and complications were observed among 68.5%, 31.5%, 11% and 4.1% of them, respectively. Admission for two hours or more was reported among 20 cases (27.4%), with no significant difference between cases of heat stroke and those with heat exhaustion. Analgesics were given to 9 patients (12.3%); more significantly in cases of heat stroke (19% versus 9.6%), p=0.045. History of transfer was reported among 9 patients (12.3%); more significantly in cases of heat stroke (23.8% versus 7.7%), p=0.041. Air condition was provided to majority of patients (94.5%) more significantly among patients with heat exhaustion than heat stroke (98.1% versus 85.7%), 0.018. Water/ice with Fam was given to 41 patients (56.2%); more significantly to patients with heat stroke (85.7% versus 44.2%).