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Preventing Heat-Induced Death and Illness

Worst Pills, Best Pills Newsletter article June, 2012

During hot summers, as many as 1,000 unnecessary deaths in the U.S. are caused by heat stress. Many of these deaths can be prevented by drinking much more fluid than is needed to simply quench thirst (the cooling caused by the evaporation of sweat is the only way people who do not have the luxury of air conditioning can survive in very hot weather) and by engaging in other heat-coping behaviors.

In hot weather, extra precautions must be taken for certain higher-risk groups, including:

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During hot summers, as many as 1,000 unnecessary deaths in the U.S. are caused by heat stress. Many of these deaths can be prevented by drinking much more fluid than is needed to simply quench thirst (the cooling caused by the evaporation of sweat is the only way people who do not have the luxury of air conditioning can survive in very hot weather) and by engaging in other heat-coping behaviors.

In hot weather, extra precautions must be taken for certain higher-risk groups, including:

  • infants younger than 1 year old
  • people over 65 years old
  • people less able to care for themselves because of chronic mental illness or dementia of any cause
  • people with chronic diseases, especially cardiovascular or kidney disease
  • people taking any of the drugs listed in the table on pages 6 and 7
  • people who work in excessively hot conditions without adequate safety precautions (at least 523 U.S. workers have been killed over the past two decades from heat stress, the subject of a 2011 Public Citizen petition available at www.citizen.org/petition-to-osha-for-a-heat-standard-2011)

Safeguards may include increased efforts to keep cool or closer observation by others for early signs of heat illness. People at higher risk for heat illness are more likely to build up dangerous levels of body heat, which may lead to one of the following three heat-related conditions.

Ways to avoid heat-induced death and illness

1. Keep as cool as possible:
  • Avoid direct sunlight.
  • Stay in the coolest available location (usually indoors).
  • Use air conditioning, if available.
  • Use electric fans to promote cooling.
  • Place wet towels or ice bags on the body, or dampen clothing.
  • Take cool baths or showers.
2. Wear lightweight, loose-fitting clothing.
 
3. Avoid strenuous physical activity, particularly in the sun and during the hottest part of the day.
 
4. Increase intake of fluids, such as water and fruit or vegetable juices. Thirst is not always a good indicator of adequacy of fluid intake. Some studies indicate that fluid intake in hot weather needs to be 1.5 times the amount that quenches thirst. Persons for whom salt or fluid is restricted should consult their physicians for instructions on appropriate fluid and salt intake. Otherwise, drink at least a gallon of liquid a day when the outside temperature is above 90 degrees and you cannot be in air-conditioned surroundings.
 
5. Do not take salt tablets unless you are instructed to do so by a physician.
 
6. Avoid alcohol (e.g., beer, wine and liquor) and caffeinated products (e.g., coffee, tea or soda) because they can cause excessive loss of fluids.
 
7. Stay in at least daily contact with other people.

Heat exhaustion

The most common form of illness due to hot weather is heat exhaustion. This condition takes longer to develop than other heat-related illnesses and results from a loss of body fluids and salt. The symptoms of heat exhaustion are thirst, fatigue, giddiness, elevated body temperature and, in severe instances, delirium. When both body water and salt are depleted, muscle cramps may also be present.

Heat exhaustion is treated by resting in bed, away from the heat, and restoring body water by drinking cool fluids, taking alcohol sponge baths (on the advice of a physician) or applying wet towels to the body.

Heat syncope (faintness, dizziness)

Heat syncope results from sudden increased exertion or a lack of acclimation to hot weather. The condition is marked by dizziness, fatigue and sudden faintness after exercising in the heat. Other symptoms include cool, sweaty, pale skin; weak pulse; and falling blood pressure.

In contrast to heat stroke (discussed in the next section), heat syncope is often resolved by removing the victim from direct heat exposure. The best additional treatment involves resting (lying or sitting down with the head lowered), cooling off and drinking extra liquids.

Drugs That Can Impair Your Response to Heat

Generic Name/Main Ingredient
Brand Name
Anticholinergics/Belladonna Alkaloids
atropine*
DONNATAL, LOMOTIL
darifenacin ENABLEX
dicyclomine* BENTYL
flavoxate URISPAS
loperamide** IMODIUM
propantheline PROBANTHINE
scopolamine TRANSDERM SCOP
tolterodine**- DETROL
trimethobenzamide* TIGAN
Antidepressants/Antipsychotics
amitriptyline*
ELAVIL, ENDEP, VANATRIP
amoxapine** ASENDIN
bupropion** WELLBUTRIN
carbamazepine TEGRETOL
chlorpromazine** THORAZINE
clomipramine ANAFRANIL
clozapine** CLOZARIL
desipramine NORPRAMIN, PERTOFRANE
doxepin** SINEQUAN
fluphenazine**
PROLIXIN
haloperidol** HALDOL
imipramine** TOFRANIL
lithium**
LITHOBID
maprotiline**
LUDIOMIL
nortriptyline
AVENTYL, PAMELOR
olanzapine** ZYPREXA
oxcarbazepine TRILEPTAL
paroxetine** PAXIL
perphenazine TRILAFON
prochlorperazine** COMPAZINE
promethazine** ATOSIL, AVOMINE, FARGAN, FARGANESSE, LERGIGAN, PROMETHEGAN, PROTHIAZINE, RECEPTOZINE, ROMERGAN
quetiapine** SEROQUEL
*risperidone**
RISPERDAL
thioridazine* MELLARIL
thiothixene** NAVANE
trazodone** DESYREL
trifluoperazine** STELAZINE
trimipramine
SURMONTIL
ziprasidone*
GEODON
Antihistamines
brompheniramine
DIMETANE
carbinoxamine PALGIC
cetirizine** ZYRTEC
Generic Name/Main Ingredient
Brand Name
Antihistamines (continued)
chlorpheniramine
CHLOR-TRIMETON
clemastine
TAVIST, TAVIST-1, TAVIST-D
cyproheptadine
PERIACTIN
desloratadine*
CLARINEX
dimenhydrinate
AIRMIT, DRAMAMINE
diphenhydramine
BENADRYL, DYTAN SUSPENSION
fexofenadine**
ALLEGRA
hydroxyzine
VISTARIL
ipratropium
ATROVENT
loratadine**
CLARITIN
meclizine
ANTIVERT
phenyltoloxamine
TUSSIONEX
triprolidine
ACTIFED
Antiparkinsonians
amantadine
SYMADINE, SYMMETREL
benztropine*
COGENTIN
bromocriptine**
PARLODEL
levodopa
LARODOPA
levodopa and carbidopa
SINEMET
trihexyphenidyl* ARTANE
Heart Drugs
acebutolol
SECTRAL
alfuzosin**
UROXATRAL
atenolol
TENORMIN
azilsartan*
EDARBI
benazepril**
LOTENSIN
bendroflumethiazide
NATURETIN
betaxolol
KERLONE
bisoprolol
ZEBETA
bumetanide**
BUMEX
candesartan**
ATACAND
captopril**
CAPOTEN
carteolol
OCUPRESS
carvedilol
COREG
chlorothiazide
DIURIL
disopyramide**
NORPACE
doxazosin*
CARDURA
enalapril**
VASOTEC
eprosartan**
TEVETEN
esmolol
BREVIBLOC
ethacrynic acid
EDECRIN
fosinopril**
MONOPRIL
furosemide**
LASIX
hydrochlorothiazide**
MICROZIDE
hydroflumethiazide
SALURON

 

Generic Name/Main Ingredient Brand Name
Heart Drugs (continued)
indapamide* LOZOL
irbesartan**  AVAPRO
isosorbide-5-mononitrate  IMDUR, MONOKET
isosorbide dinitrate  ISORDIL
labetalol TRANDATE
lisinopril** PRINIVIL, ZESTRIL
losartan**  COZAAR
methyclothiazide  ENDURON
metolazone  ZAROXOLYN
metoprolol LOPRESSOR LOPRESSOR
moexipril** UNNASC
nadolol CORGARD
nebivolol  BYSTOLIC
nitroglycerin  MINITRAN, NITRODUR, NITROSTAT
olmesartan**  BENICAR
penbutolol  LEVATOL
perindopril**  ACEON
pindolol  VISKEN
prazosin*  MINIPRESS
propranolol  INDERAL, INDERAL LA
Generic Name/Main Ingredient Brand Name
Heart Drugs (continued)
quinapril ACCUPRIL
ramipril** ALTACE
spironolactone** ALDACTONE
telmisartan** MICARDIS
terazosin* HYTRIN
timolol BLOCADREN
torsemide DEMADEX
trandolapril** MAVIK
valsartan** DIOVAN
Oral Diabetes Drugs
acetohexamide* DYMELOR
chlorpropamide* DIABINESE, INSULASE
glimepiride** AMARYL
glipizide** GLUCOTROL
glyburide** DIABETA
tolazamide** TOLINASE
Other Drugs 
cyclobenzaprine* FLEXERIL
meperidine DEMEROL
methocarbamol* ROBAXIN
orphenadrine* NORFLEX, NORGESIC FORTE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Do Not Use
** Limited Use (offers limited benefit or benefits certain people or conditions)
Note: This table is not an exhaustive list. Consult your doctor to ensure that you are not taking a drug that can impair your response to heat. Many of the drugs mentioned here are also in combination products or in other dosage forms not listed. Check with your doctor or pharmacist to ascertain if any of the drugs you are taking contain any of these drugs. Many heart drugs contain hydrochlorothiazide.

 

Heat stroke

A life-threatening medical emergency, heat stroke or collapse requires immediate attention by a doctor or other properly trained medical personnel. The symptoms of heat stroke include faintness, dizziness, staggering, headache, nausea, loss of consciousness, high body temperature (104 degrees Fahrenheit / 40 degrees Celsius or higher), strong rapid pulse and flushed skin. In severe cases, blood pressure drops as circulation fails, and death can ensue.

What You Can Do

Because body heat can continue to build up for days after a heat wave ends, doctors and others who care for the elderly or the ill should monitor body temperatures closely during and after periods of extreme heat.

If you are taking any of the drugs listed in the tables above, it is even more important that you follow the guidelines in the “Ways to Avoid Heat- Induced Death and Illness” box.

Much of the information in this article defining heat exhaustion, heat syncope and heat stroke was published in 1980 in the Centers for Disease Control and Prevention bulletin Morbidity and Mortality Weekly Report following a complaint by Public Citizen’s Health Research Group that the government had given out dangerously incomplete information about how to survive the heat. The list of drugs has been updated periodically, including for this article.