. EFFECTS OF HEAT Clinical manifestations -1. Heat fever -is common in the aged and in children

mg/day. 5. Treatment of anemia and other deficiences - (a) Vitamin B12 50-100 mcg twice a week together with folic acid foroptimal haemopotetic response. (b) Vitamin B complex. (c) Pancreatic enzyme tablets 0.4 gm b.d after meals. (d) Calcium salts and vitamin D. (e) Transitions in severely anemic patients 21. EFFECTS OF HEAT Clinical manifestations -1. Heat fever -is common in the aged and in children in summer months. Fever is continuous in the range of 101°-104° F and may have a spontaneous onset or follow about a week after surgery. A change in the mental state af the patient (apathy, drowsiness) may occur after about a fortnight of pyrexia wtlh tremuiousness of the hands and increased tone in the extremities Drowsiness rnay progress to coma and if undiagnosed may result in death. Treatment - Shifting the patient to cooler environment and mainfenance of electrolyte balance, 2. Heat cramps -of striated muscle from excessive salt loss due to profuse sweating in high environmental temperatures. it is common in boiler room workers, steel workers and miners Calt muscles are rnost commonly affected but cramps may occur in the chest, and when affecting abdominal muscles stimulate an acute abdomen. Treatment - Cramps can be rapidly relieved by drinking fluids containing sodium chloride or by 1/2-1 litre of normal saline IV. 3. Heat syncope -A fainting spell or 'blackout' from excessive heat and humidity. The individual drops to the ground it standing and there is transient loss of consciousness. Treatment - Lying down flat in cool surroundings is followed by quick recovery 4. Heat stroke (Sunstroke, heat hyperpyrexia) - Characterised by sudden loss of consciousness which may be preceded by prodromal signs typical of cerebral irritation - headache, dizziness, nausea, convulsions, and visual disturbances. Failure of the heat regulating centre gives rise to high fever and cessation of sweating. On examination Ihe skin is hot and flushed and dry. pulse rapid, irregular and weak and low B.P. Temperature may reach between 105°-107°F. If the patient is not treated the temperature continues to rise and a state of hyperpyrexia supervenes Managament - (a) Cooling by fanning after sprinkling with water. Immersion in cold water or use of ice packs or ice water enemas. (B) Massage of extremities to maintain circulation. (c) Sedatives contraindicated unless convulsions. (d) Normal saline 1000ml. IV slowly if dehydration or cramps, 5. Heat ehaustion -Three types: (a) Due to anhidrosis -Due to acute heat stress after long residence in tropics, may follow prickly heat. Feeling of heat and exhaustion and headache, gladdiness and palpitation. Fever 95-100°F, tachycardia and increased respiratory rate. Gollaps and coma may occur. Management -Removal to cool surroundings. (b) Due to salt deficiency - Predominant salt depletion prone to occur during