Homoeopathy for sunstroke

Dr Amrutha Manoharan

ABSTRACT
Sun stroke is the most commonly faced condition in our country, exposure to hot environment is the major cause. the problem of sun stroke has to be managed effectively, otherwise it may lead to many complications. 

KEY WORDS : Sun stroke, Pathophysiology, Clinical features, Complications, homoeopathic management.

INTRODUCTION
Sun stroke is a life threatening medical emergency. the hall marks of heat stroke are cerebral dysfunction with core temperature over 40 degree and absence of sweating.

Triggers of Heatstroke

Exposure to a hot environment caused by a hot environment that leads to a rise in body temperature, without strenuous physical activity. This type of heatstroke typically occurs in hot, humid weather, especially for prolonged periods. It occurs most often in older adults and in people with chronic illness.

• Strenuous activity – Anyone exercising or working in hot weather can get EHS, but it’s most likely to occur if not accustomed to high temperatures
• Wearing excess clothing that prevents your sweat from evaporating easily and cooling your body
• Drinking alcohol which can affect your body’s ability to regulate your temperature
• Becoming dehydrated because you’re not drinking enough water to replenish fluids you lose through perspiration. ^[1]

PATHOGENESIS  AND PATHOPHYSIOLOGY

Thermoregulation is a highly complex inbuilt mechanism to maintain a constant range of temperature, which essential for normal functioning of the internal milieu. Any abnormal increase in temperature is gauged by the hypothalamic thermoregulatory centre resulting in a reflex cutaneous vasodilatation and augmenting the skin blood flow. ^[1]

Failure of normal cardiovascular adaptation to severe heat stress, exaggerated acute phase response and attenuated heat-shock proteins response are the main reasons which lead to sun stroke. ^[2]

Sun stroke and its progression to MODS result from complex interaction of acute physiological alterations associated with hyperthermia (increased metabolic demand, circulatory failure and hypoxia), direct cytotoxicity of heat, and inflammatory and coagulation responses of the host. This results in alteration in microcirculation and consequent damage to vascular endothelium and tissues. ^[3]

Increased intestinal permeability mainly due to gut ischaemia (most of the cardiac output is diverted to exerting muscles and other peripheral organs) may lead to endotoxemia resulting in excessive production of inflammatory cytokines which induce endothelial cell activation and release of nitric oxide and endothelins.^[4]

CLINICAL FEATURES
Raised body temperature and CNS dysfunction are common to both classic and exertional sun stroke ^[5]. Classic sun stroke victims usually present with hot dry skin, tachypnoea, tachycardia and hypotension. From other forms of heat illness in sun stroke altered mental status is seen hence, any person who becomes irrational or confused or collapses following heat stress with or without physical activity, should be presumed to have sun stroke regardless of core temperature and immediately given appropriate treatment. ^[6]

COMPLICATIONS IN HEAT STROKE

• Seizures
• Hypotension
• Disseminated intravascular coagulation–This is a result of consumptive coagulopathy and presents with bleeding from multiple sites
• Adult respiratory distress syndrome
• Renal failure – May require haemodialysis
• Rhabdomyolysis – Volume depletion, renal injury, and muscle injury can lead to rhabdomyolysis. It presents with myogobinuria
• Multiorgan failure. ^[7]

LABORATORY FINDINGS

• Dehydration
• Leucytosis
• Elevated BUN
• Hyperuricemina
• Acid base abnormality
• Decrease serum sodium and potassium.
• Elevated creatinine, cardiac markers. 
• Uris concentrated with proteinuria.
• ECG changes include ST-T changes. ^[8]

DIAGNOSIS

Diagnostic Criteria for Heatstroke

1. Hyperpyrexia (>40 °C core body temperature) with alteration in mental status:
   1. Subtle: mild confusion, inappropriate behaviour, impaired judgement
   2. Severe: delirium, encephalopathy, convulsions, coma
2. High ambient temperature
   1. Non-exertional heatstroke occurs in high ambient temperature (heatwave conditions)
   2. Exertional heatstroke usually occurs in the setting of unaccustomed heavy exercise or strenuous physical activity with or without high ambient temperature.
3. Predisposing conditions: Extremes of age/underlying predisposing chronic illness
4. Associated clinical findings: Hot, dry skin, absence of sweating, clinical signs of dehydration.

PREVENTING PROGRESSION OF HEAT EXHAUSTION TO SUN STROKE
To avoid heat exhaustion, drink water (up to a litre an hour), salted buttermilk, rice water, lime or mango juice, lentil soup till thirst is quenched and there is adequate urine output.

Avoid alcohol and carbonated beverages, avoid sun, wear light, loose clothing and cover the head, limit exertion, rest in shade, spray water and lie down under the fan or rest in an air-conditioned room, if available,  have cool baths to lower temperature,  rest at shorter intervals during work hours.
Move the victim to a cool place and rapidly cool the body as described under therapeutic cooling.

When should patients be referred to a higher level of medical care?

After initial stabilization and cooling, patients with heatstroke and altered consciousness should be quickly transported to a hospital with emergency facilities and intensive care.

Hospital preparedness
Hospitals should establish the following steps to diagnose, treat and prevent sun strokes at the onset of summer:

1. Administrative planning meetings, weekly review and daily tracking of cases and mortality during an epidemic
2. Develop and disseminate ‘heatstroke protocol’ to all medical and nursing staff
3. Ensure cooling supplies and equipment: Ice blocks, refrigerated intravenous (i.v.) fluids, spraying devices, air coolers, pedestal fans, sponges
4. Convenient designated cooling areas, preferably air-conditioned and with adequate nursing staff
5. Nursing staff and doctors to watch for heatstroke among inpatients with fever and predisposing factors. Increase fluid intake of all inpatients based on estimated insensible losses
6. Outpatient area measures: Avoid long queues, triage and fast track patients who are chronically ill, ensure availability of drinking water, warn all patients and relatives about prevention and early recognition of heat exhaustion
7. Alert public health authorities and media about the status of epidemic. ^[9]

DIFFERENTIAL DIAGNOSIS
Heatstroke needs to be differentiated from certain encephalopathies like falciparum malaria, viral/bacterial meningoencephalitis. Sepsis, thyroid storm, pheochromocytoma, diabetic ketoacidosis, gastroenteritis, and pontine haemorrhage can also be confused with HS. Drug-induced hyperthermia, neuroleptic malignant syndrome, and MH should also be considered in the differential diagnosis and a proper history should be obtained. ^[10]

MEDICINES FOR SUN STROKE

ACONITE
In sunstroke which comes suddenly with great intensity.  Worse when falling asleep in the sun. There is strong headache and photophobia.  Face congested and pupils constricted.

BELLADONA
Severe throbbing headache with flushed red face. Sunstroke after falling asleep in sun.Throbbing and pulsing head pain. Hot flushed face but body becomes chilled. Headache worse on right side and lying down. ^[13]

CARBO VEGETABILIS
Weakness and collapse after exposure to heat and sun. fainting from heat exhaustion. Patient becomes cold and clammy and marked Diarrhea.Diarrhea after exposure to heat and sun.

CUPPRUM
Severe cramps in abdomen or legs following heat exhaustion. Face becomes pale and there is marked prostration.

GELSEMIUM
Weak and tremulous after exposure to heat and sun. face flushed and head congested. Vertigo and dizziness. Headache in occiput after exposure to sun. General depression from heat of sun or summer. ^[14]

GLONOINUM
Violent headache with throbbing, flushed face and visible pulsation of carotids. Severe headache after exposure to sun, better by wearing a hat.  Vertigo and dizziness. Hot skin, drowsy, frequent urination.

LACHESIS
Severe headache after exposure to sun, worse left side, tight  collars, chilliness and weakness after walking in hat of sun. cold feet after walking in the sun.

NATRUM CARBONICUM
Sunstroke, both acutely and chronic effects of sunstroke. Confusion and vertigo after exposure to sun. heaviness and dullness in the head. Severe headache from least sun especially after sunstroke. Weakness after walking in sun.

SELENIUM
Extreme weakness after exposure to sun.

Tincture of camphor for brain fever from sun stroke use one drop of saturated solution in sufficient sugar of milk every hour until the symptoms abate.^[12]

BIBLIOGRAPHY

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Dr. Amrutha Manoharan, B.H.M.S, M.D(Hom.), Dip Yoga
Assistant Professor, Department Of Physiology.
White Memorial Homoeopathic Medical College, Attor. Tamil Nadu.