With the recent stretch of hot weather we've had lately and more in the forecast, it's time to start thinking about the dog days of summer. Although I don't see a significant number of heat-related emergencies in my office, many patients do end up in emergency departments suffering from exposure.

Deaths from heat-related illness range from 300 to several thousand per year in the U.S. The number is markedly increased during heat waves. There are tens of thousands of visits each year to doctors' offices and emergency rooms.

Risk factors that make one more prone to heat-related illness include being elderly or very young, being obese, using prescription or non-prescription drugs (especially alcohol, cocaine, antihistamines, beta blockers, diuretics and some psychiatric medications among others). Workers like firefighters, who have to wear heavy clothing are also at high risk.

Heat exhaustion is caused by excessive loss of body water and salt. Heat exhaustion typically comes on slowly and is characterized by fatigue, weakness, nausea, vomiting, headache, muscle aches, cramping, dizziness, and irritability. Frequently these folks are sweating profusely, are pale with clammy skin, and have a weak, rapid pulse. They have reduced blood flow, commonly known as shock.

The first thing to do for someone with heat exhaustion is to remove him or her from the warm environment. Standard treatment for shock should then be administered - elevate the legs and replace the lost salt and water. Sports drinks (Gatorade® or Powerade®) are excellent sources of water and lost electrolytes.

If a victim shows signs of confusion or lethargy, or is not responding to treatment, he or she should be taken to the emergency department. The prognosis for heat exhaustion is very good.

Heat Stroke (HS) results from either inadequate or malfunctioning body temperature regulating mechanisms. It can be from heat absorption from the environment and/or heat production from physical exercise. These can cause dangerously high internal body temperatures. Heat stroke is a medical emergency and is frequently fatal without immediate treatment.

Symptoms of heat stroke typically come on rapidly and include headache, dizziness, fatigue, weakness, and perhaps a sudden loss of consciousness. Physical findings include confusion, hot & dry skin, decreased sweating, rapid pulse, vomiting and perhaps seizures.

The initial treatment for someone with heat stroke is to call 911 and move the victim to a cool area. Placing ice packs in the armpits and on the groin, neck and abdomen helps cool the patient down. Running a fan on the patient and spraying them with tepid water can be very helpful (think mist fans on the sidelines of the NFL). Immersing a victim in cold water is not recommended.

As with any medical emergency, the key is prevention. When you're in the sun or a hot environment for an extended period, be sure to maintain your hydration. Water will do just fine unless you're involved in intense physical activity for more than an hour. If that's the case, I recommend sports drinks. Salt tablets are not recommended.

You should drink roughly 16 ounces of fluid about two hours before outdoor activity if possible. During activity, drink 4 to 8 ounces every 20 minutes. A crude measure of adequate hydration is the color of your urine - clear or pale yellow is what you're shooting for.

If you take prescription medication, be sure and read the warnings you receive from the pharmacist or talk to your doctor to determine if it might affect your sensitivity to heat. If you develop any of the symptoms mentioned above, tell someone and get to a cool environment immediately.