Dog days and siriasis. How to kill a football player

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Abstract
Heat stroke is apt to occur in the hot months of July and Aug. when the dog star, Sirius, rises each morning with the sun, and was thus named siriasis. Heat stroke is an acute medical emergency with 3 major manifestations: profound dysfunction of the CNS; a hot, dry skin; and a rectal temperature exceeding 40.6.degree. C (105.degree. F). It may occur in healthy individuals performing work at such intensity that the heat produced from muscle contraction cannot be dissipated into the environment with sufficient speed. The heat load mounts progressively and hyperpyrexia follows. In nearly all cases induced by exertion, skeletal muscle necrosis (rhabdomyolysis) coexists. In contrast, the classic variety of heat stroke need not be associated with exertion. In nearly all cases, certain factors are identifiable retrospectively that favored development of exertional heat stroke. Intentional or even permissive dehydration is treacherous. If salt is ingested, water consumption is mandatory. Otherwise, the usual hypernatremia resulting from loss of sweat will be exaggerated. Several reports have implicated amphetamines in the pathogenesis of hyperthermia in association with massive death of skeletal muscle. About half the patients with acute heat stroke are hypokalemic. This does not necessarily indicate deficiency. In healthy young men training in hot climates a fairly serious deficiency of body K may develop. Normal individuals develop hyperkalemia during intense exercise as a result of K release from contracting muscle cells. The injudicious administration of K, especially to dehydrated individuals, might exaggerate the hyperkalemic response to exercise and lead to sudden death. Effective rules for preventing heat stroke have been developed and widely publicized. Nevertheless, a number of individuals responsible for the training and conditioning of high school and college football players are either unaware, careless or forget that heat stroke has killed players. Knowledge of heat illness, the limits of physical tolerance and free access to water will go a long way in heat stroke prevention.

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