The summertime sepsis mimic physicians can’t afford to miss
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Heat illness is a spectrum, with the main differentiator being mental status. Once a patient exhibits altered mental status, confusion, etc., the patient should be considered to be suffering from heat stroke until proven otherwise.
—Bryan Beaver, MD
Summer is here, and along with it come cases of heat-related illness. With average temperatures rising, experts say it is more important than ever for physicians to be alert to the dangers of heat stroke.
“Heat has the potential to do great harm. Although heat-related illness sits on a spectrum, once a patient progresses to the dreaded heat stroke, where one loses their ability to control their core temperature, you’re dealing with a high-mortality, time-sensitive emergency. Even with treatment, outcomes depend on how quickly you can recognize it and lower the core temperature,” Solomon Behar, MD, pediatric emergency medicine physician at Miller Children’s and Women’s Hospital and MemorialCare Long Beach Medical Center in Long Beach, CA, tells MDLinx.
By 2050, it is estimated that deaths from heat stroke will increase 2.5 times. [] Part of the challenge for physicians is that heat stroke can present in a similar way to infections or other conditions. Case studies have demonstrated that patients may even present with a sepsis-like reaction and organ failure. []
“What makes it challenging is that early presentations are often nonspecific, including fatigue, dizziness, mild confusion, and these can be mistaken for dehydration, infection, or general deconditioning. If you’re not considering heat exposure–related illness, it’s easy to miss,” Dr. Behar says.
Related: These dangerous conditions are caused by summer heatCooling is the priority
Bryan Beaver, MD, is an emergency medicine physician at the University of Kansas Health System. He says that physicians should still prioritize cooling measures in patients suspected with heat stroke, even when exploring other differential diagnoses like sepsis.
“While these etiologies should be considered simultaneously, a key differentiator is the context: recent exposure to a hot environment, exertion in the heat, etc,” he tells MDLinx. “If heat stroke is suspected, the priority should be to focus on cooling measures immediately. If other etiologies such as sepsis are included in the differential diagnosis, these can be worked up concurrently but should not delay the cooling of the patient.”
Dr. Beaver continues, "Heat illness is a spectrum, with the main differentiator being mental status. Once a patient exhibits altered mental status, confusion, etc., the patient should be considered to be suffering from heat stroke until proven otherwise."
Climate change poses a challenge
Due to climate change, average temperatures across the US are increasing, along with heat waves and extreme temperatures, defined as days where the temperature reaches 95˚ F. [] Extreme heat–related events pose a challenge not only for patients but for health systems and physicians as well.
“Recent heat waves in the US have put tens of millions of people living in areas with a heat index over 103,” says David Cutler, MD, board-certified family medicine physician at Providence Saint Johns Family Medicine in Santa Monica, CA. “This can lead to overwhelmed health care facilities and electrical supplies as people turn on the air conditioning. This is especially important for the frail, the elderly, the very young, and those on medications which may impair their ability to control body temperature.”