Yesterday I was hospitalized with heatstroke and severe dehydration in Chennai. Help

drsoptics

I want to let the IM community know what happened to me, (1) to warn people about heatstroke, and (2) to ask for advice to prevent it.

Yesterday morning I was slightly tired but didn't think much of it, I spend the morning in an AC museum. Then I had lunch in an AC house with a host family in Chennai. My stomach hurt slightly. After a couple hours rest, I went to see the basilica, and spent time inside and inside in AC. Tired, I took an autorickshaw back to my host family's house. During the rickshaw ride my hands and finger started getting tingly, followed by my lips and feet. I told the driver to take to to a hospital. After just a couple of minutes, the muscles in my hands and fingers cramped up so completely that my mobile phone was locked in my left hand. I physically could not move my fingers to get the phone out. I was rushed into the hostpial, and IV, electrolytes, and half an hour later, I was much better and my fever had gone down. My sodium levels were down and my potassium was borderline. When the main doctor came, the diagnosis was heatsroke and severe dehydration. I thought this was surprising because I was not thirsty, I had drank 2 liters so far that day (by 5pm) and I was inside pretty much all day. But chennai is hotter and humider than you'd think.

My questions for the IM community are : Has this ever happened to anyone before? Where your hands cramp up? I got recommendations from the doctor to consume electrolytes and EC water, to drink a lot, and to rest. Any more basic, general suggestions on staying healthy in India?

On a broader level, this is really hard for me. I just landed in Delhi last Friday, suffered through the barrage of touts on Paharganj for a couple of days, flew to Chennai, was in a taxi that caused a car accident on Day 4 in India (http://drsoptics.blogspot.com/), and got hospitalized on Day 5. Now I am going to rest for a couple of days. I know this trip has to start getting better because there is no where else to go but up.

I have 5 weeks before my girlfriend comes to Delhi, I was going to do South India myself during that time and the North with her. Given the heat down here I was thinking of scrapping that plan and going to the hills (J&K or HP) for 4 weeks instead of the South. I have money to fly, its no problem. Or I could try to do some combination of a few hill stations in the south for 1 week and then Himalayas for 4 weeks until I meet my gf in Delhi. Any suggestions? Every Indian I've talked to has said "you have chosen a difficult time to visit India" If this is really true, why shoot myself in the foot when I could go somewhere a little cooler?

Thanks in advance!

nomad

glad that you are fine now and hope that rest of your stay will be pleasant.

you can go to Munnar,vaghamon, wayanad(lakkidi) etc for these 4 weeks

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Bhaswaran

You can also go to the hill stations like Ooty-Conoor-Kotagiri circuit or Kodaikanal in Tamil Nadi, Munnar or Ponmudi in Kerala, or Madikeri in Karnataka. Ooty-Conoor will be cooler. Hope you in the best of your health.

70s-80s overlander

The main message here is that drinking too much water can wash out some of your body's key minerals -- in this case, you probably had washed out a lot of your magnesium. Dal (lentils) would be an Indian dish readily available and high in magnesium; bananas or nuts could also fill that role. This is not to say that sipping fluids all day is a bad thing; it is just to say that eating with the fluids is a good idea.

Heat stroke makes the muscles go "rubbery" and the heart rate go up; in your case, the faster heart rate led to faster breathing -- which brought on alkalosis of the blood which, with dehydration, caused the calcium in your blood to have a higher effective concentration, which caused your muscles to cramp. [I tried to put this in Plain English.] Again, sipping fluids along with eating a high magnesium food would have helped at this time, as would have lying down, to relax, toward slowing your heart rate and breathing.

So, now you are "older and wiser". Not to worry. Enjoy India BUT hydrate yourself until you urinate clear every morning, keep eating, and wet down your head, hands, shirt, etc, whenever possible. If possible, if it is super hot, travel at sun up and sun down, resting/sleeping at mid-day.

steven_ber

I'm glad things are better now, and I'm looking forward to reading the replies.

You have one character too many in your link to the blog, the following link is correct.

http://drsoptics.blogspot.com/

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steven_ber

Great info, and plain enough for me to understand.

So, we start to pee, if it isn't clear, we stop, take some more water, then start to pee again, if it still isn't clear, we stop, drinks some water and...... (I'm imagining Mr Bean attempting this )

Don't worry, just joking, I totally understand what your saying.

Nick-H

First the bad news. Chennai will get noticably hotter day by day over the next month or even two, and will be at least as hot as it is now through July and August. It is only in the past week that I have started using my AC indoors in the day time: there is a big difference between 30 at my desk and 32.5 at my desk, and that has happened in a few days. The outside temperature should be touching 40 within the next week or two. (unless it rains; like the rest of us, you could try praying!). If it is not already, then you will soon find the wind that blows on you, as you travel by auto, to feel hot instead of refreshing.

You would certainly find things cooler up in the hills. Even on the Kerala side the temperatures will not rise as high as Chennai, although the sun there burns me more than it does here, so I'm not sure I should recommend it.

You have been diagnosed in hospital and the treatment has hit the spot, so I cannot argue with a pro diagnosis and successful outcome --- but I am astonished that so little exposure has resulted in sunstroke.

In 2004, when I was finding my way around this city and doing a couple of hours walking every day, on one occasion I had just left the guest house and suddenly felt exhausted. I turned round, returned to my room, turned on the AC and went to bed for the day. After that I was fine. I don't think I was suffering from heatstroke at that point, but if I had not headed my body's warning I am certain I would have been by the end of the day. Having heeded my body's message I was back in action the next day.

So the first advice is if you get warning signs from your body then heed them. But I think for some, heatstroke is something that can hit suddenly; so don't wait for those signs.

I'm sure anything else I can say is already in the guidebooks etc.

• Wear a hat or use an Umbrella. Or both. Keep your head and the back of your neck covered.
• Keep your skin covered, use sunblock, to help prevent burning.
• Walk on the shady side of the street!
• Slow Down! Those of us who come from cities like London take a while to realise that there is a good reason that things happen slowly here!
• Try to go out early in the day. Mad dogs and Englishmen may go out in the midday sun, but once things have really heated up they will stay hot until early evening.
• Drink! little and often is better than half a bottle at a time, but it should total several litres a day. Remember you need salt and sugar as well. Do not wait until you are thirsty --- if you are dehydrated already you may not feel it

There's bound to be something I forgot there... Maybe like stopping at a juice stall a couple of times a day for sweet lime or melon juice or which-ever takes your fancy.

...Several posts while I was writing this, so I'll check out everybody else's advice now

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Nick-H

Urine --- an important danger sign that I missed completely: not urinating, or passing dark urine.

Steven... you have to take a 20Ltr can of water into the toilet, and stay there until what comes out is the same colour as what you drink!

I used to add about 1/4 tsp salt (you can't even taste it) to a litre of water.

These days Mrs N makes a delecious drink by adding the juice of two small limes with a little salt and sugar to a litre bottle of water.

capt_mahajan

I think Nick is describing heat exhaustion here, which is a bit different from heatstroke.

Some good advice from 70s-80s there. Heatstroke can also make you listless.

A person who is listless, may not feel thirsty because s/he has been drinking water.. just not enough.


If possible, dilute fruit juice with water and drink.

cyberhippie

You can also use ORT to keep you balanced. There's no need to wait until you are severely dehydrated until you use rehydration salts. They are ok to use very few days!!

beklemmung

Glad to hear you're OK, David. My first couple days were trying too, though not nearly to the extent yours have been. If you decide to hang around in the South for a bit, I'm going to be arriving in Kerala (in Kannur) on April 30th, and traveling around the state for around three weeks.

The heat in the northern plains (UP, Punjab) shocked me when I came out of the mountains a week ago, but I've adjusted to it considerably. I'd still call it barely tolerable, and I'm looking forward to Kerala being slightly cooler, especially when I get to the hills there!

bijapuri

water on a headrag, usually a bandana in my case, helps for me. I've looked around in Bangalore for Magnesium tabs, no luck.

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sudheer poppa

Water melon, Tender Coconut, Lemon water are the popular coolants that the locals fallback to. No reason why it should not work for the travellers. There would be countless juice shops in most places in the south and especially in Kerala these are quite safe. To be extra safe, you can ask them to make your's without water and ice there by getting only the fresh juice alone.

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GracefulTravel

I started adding rehydration salts that I had brought with me to my drinking water. It made a huge difference in how I felt. I brought them for emergency purposes, but realized after a few days in intense heat to which which I was not yet accustomed, that I was not perspiring enough and that I was a little light-headed at times. I was drinking lots of bottled water throughout the day, but realized that a lot of it is filtered, processed water that removes the minerals and salts that normally would be in the water. So, either adding some kind of electrolytes, or taking a combination of some kind of salt and sugar does seem to make a huge difference. There are some brands of bottled water that add minerals after the filtration process -- they were ok, I guess, but didn't have the same effect on me as adding the salts myself. I had also brought a water filter bottle as I didn't want to keep buying and throwing away plastic bottles; it worked as far as filtration, but it also removed all the good minerals and salts.
If you have the option of going to someplace cooler for the next few weeks, then why not go; enjoy your trip. I hope you continue to feel better.

Nick-H

I don't think any drinking water has ---or should have--- more than the most minute, minuscule mineral traces in it. I wouldn't worry about that, or their removal, at all.

After all, we all used to survive before some clever marketing people started selling us 'mineral' water.

Remember that some of us live on this reverse-osmosis-treated water for months, years, even lifetimes.

Bear in mind that rehydration salts are for cases of severe diarrhoea --- when the body is literally pouring its water away; a loss which can be (and in infants regularly is) lethal. It is also a situation in which our bodies are just not going to be absorbing any nutrients we do consume.

So long as the digestive system is working properly, I'm sure that enough salt and sugar gets taken in --- though a little added to drinking water seems like a good idea.

I'd be very interested to hear a medical person's opinion on this...