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"Older people are usually not as fit and may suffer from other medical conditions, making them more prone to complications when hit by heatstroke."
Dr Phua Ghee Chee, Consultant, Department of Resp iratory and Critical Care Medicine, Singapore General Hospital
Staying hydrated and adequately protected from the heat may save you more than just a sunburn – it may save your life.
The weather’s getting hotter but it’s not marathoners or extreme sports enthusiasts who are catching the attention of doctors.
Doctors who treat people for heatstroke have noticed the quiet emergence of another group of patients seeking treatment for heat-related disorders – elderly spa clients.
One of them, a woman in her 70s, fell asleep in the sauna and was unconscious by the time staff at the spa found her. She was rushed to Singapore General Hospital (SGH) with a very high body temperature. Doctors managed to cool her down by lowering her temperature to normal, but she later died because of complications related to other medical conditions.
At least one other elderly woman is known to have suffered from heatstroke after staying for too long in a sauna or steam bath. She too eventually died.
Dr Phua Ghee Chee, Consultant, Department of Respiratory and Critical Care Medicine, SGH, said: “(Treating people for) exertional heatstroke is less common now because people are more aware of the dangers of doing strenuous exercise or sports without proper hydration or preparation.”
“Non-exertional heatstroke – usually seen in the elderly or extremely young – is becoming more common. Older people are usually not as fit and may suffer from other medical conditions, making them more prone to complications when hit by heatstroke. As for small kids, they can’t regulate their body temperatures as well as adults.”
Many people may not realise they are getting heatstroke until the condition becomes severe. Symptoms such as thirst, profuse sweating, giddiness and nausea may be dismissed as minor discomforts. Without treatment, the body temperature can go sky high, rising to at least 41°C, and the person can become confused and disoriented.
Heatstroke can cause seizures, brain injury, and problems with the liver, kidneys and circulation. It can also affect the blood’s ability to clot. When the body is severely dehydrated, “blood pressure drops as blood vessels dilate, and not enough oxygen is supplied to the kidneys. Muscles are also not getting enough blood supply, causing cells to start leaking enzymes and proteins, which then clog up the kidneys,” said Dr Chew Huck Chin, Associate Consultant, Department of Respiratory and Critical Care Medicine, SGH.
One of the fastest ways of removing heat from the body is by spraying it with a fine mist of lukewarm water. “We spray the body from all directions with finely misted room-temperature water. A fan blows to evaporate this water off the skin. When water evaporates, it lowers the body’s temperature very quickly,” said Dr Phua.
“The bigger the area that is misted, the faster the body is able to lose heat,” Dr Phua added. Ice-cold water is unsuitable because it causes the patient to shiver – the body’s natural reaction to keep warm – and that causes heat to be retained instead.
When rushed to the intensive care unit (ICU), heatstroke patients may have low blood pressure and may not be breathing adequately, so a breathing tube and an intravenous drip are usually used. An ICU doctor and a nurse are also with these patients in the cooling room to monitor their condition. A rectal thermometer is inserted to check the patient's temperature.
For very severe cases of heatstroke, a device known as an endovascular cooler is inserted into the large blood vessel in the thigh, much like dialysis, to cool the blood. Another method is to run water – through a tube inserted either through the nose to the stomach, or surgically – to cool the body. For milder forms of heat disorders, special cooling blankets (cooled to low temperatures), cooling pads or ice packs are used.
 
Left: Dr Phua Ghee Chee (right) and Dr Chew Huck Chin (left) are seeing more elderly
spa visitors who suffer from heatstroke. Right: An ICU nurse prepares the misting room.
Nozzles above and below the misting bed ensure the patient’s body is coated all over with
a fine mist of lukewarm water.
Beat the heat with these tips:
- Diuretic and some psychiatric drugs can prevent the body from losing heat quickly.
- People who are obese or old have to be particularly careful not to dehydrate or overheat. Old people may not be able to move about easily, turn on the fan or air conditioner when the weather gets too hot, or drink as frequently as they should. But drinking enough water and sitting in a cool environment are important in hot weather.
- When training for a marathon, be sure to practise outside to get used to weather conditions. Running in the gym is vastly different from running in hot, humid weather.
- While proper hydration is crucial before marathons, or before any exercise, water may not be best as it doesn’t help replace the salts lost through sweating. An imbalance of salts leads to cramps or weakness of the arms. Isotonic drinks may be better.
- Avoid exercise when feeling unwell, as it can make you more likely to suffer from heat exhaustion.
- A quick way of cooling the body is to dip a sponge or towel in cold water and press it on the neck, armpits and groin area. If heat symptoms persist, seek medical attention immediately.
- Thirst is not as good an indicator of dehydration as the colour of the urine. A clear colour means the body is well hydrated.
- People suffering from multiple long-term medical conditions such as hypertension and diabetes should get out of saunas, hot tubs or steam rooms when they feel giddy or faint, have a headache, nausea or cramps. It’s best to go with someone who is able to help you if you suddenly feel sick.
An ICU doctor and nurse monitor the patient’s condition during treatment.
Ref: V10
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