Extreme heat, medication can combine to create extreme health risks

The mercury’s rising across the country, and with the rising temperature comes increased risk of a potentially fatal illness: heat stroke.

The Milwaukee County Medical Examiner’s Office released reports Monday which show five deaths last week could be heat related. Heat-related deaths were also reported in La Crosse, Lone Rock and Janesville, and the death of an Onalaska man is also being investigated as possibly related to the heat.

But, did you know that mental illness and some medications used to treat mental illnesses actually increase the risk for heat stroke? Recently, the Substance Abuse and Mental Health Services Administration blogged this warning, and in this 2006 press release, the National Alliance on Mental Illness appealed to the news media and other authorities to publicize heightened risks of heat exhaustion and heat stroke for people with mental illnesses who take psychiatric medications.

Family and friends should always check in with loved ones living with mental illness to ensure their safety.  Disturbingly, individuals with mental illness may be particularly susceptible to heat stroke.

Certain medications, including anti-psychotics and anti-cholinergics, are known to increase the risk for heat stroke because they inhibit the body’s ability to regulate its temperature. Psychiatric medications—particularly antipsychotics, lithium and topirmate—affect the body’s ability to stay cool by causing a decrease in sweating, promoting fluid loss and dehydration, or changing how people experience heat; i.e., they may not even feel heat.

Additionally, people with mental illnesses who live in low-income housing without air conditioning are also at an increased risk for heat stroke. This combination can be dangerous; According to NAMI, during a 1999 heat wave in Cincinnati, Ohio, almost half of the 18 heat-related deaths were individuals with a mental illness. The Ohio Department of Mental Health provides this information

Heatstroke is the most severe of the heat-related illnesses, and is a medical emergency. It occurs when the body’s temperature-regulating system breaks down. The victim can’t sweat and is unable to cool himself. Internal body temperature can rise as high as 108 degrees, which can cause irreversible brain damage and death. High internal temperatures can injure almost every organ, including the liver, kidneys, lungs, heart, and muscle. It can cause permanent disability and even death.

A few facts about heat stroke:

  • It’s more likely when the outside temperature is very hot. A heat wave is defined by the National Weather Service as three or more consecutive days of temperatures at or above 90°F (32.2°C ).
  • Hyperpyrexia (core temperature greater than 105°F [40.6°C]) and central nervous system impairment causing delirium or coma are characteristic.
  • The death rate for heatstroke ranges from 10% to 75%, depending on several variables, including how promptly treatment is sought.
  • Mentally ill patients are a high-risk group. Some may not have the cognitive abilities to protect themselves; others may be taking psychotropic medications that affect heat regulation.

If you are taking one or more of the following medications or products, please be extremely cautious and avoid unnecessary or prolonged exposure to the extreme heat and high temperatures.

Antipsychotics, especially:

  • Chlorpromazine (Thorazine)
  • Thioridazine (Mellaril)
  • Mesoridazine (Serentil)
  • Clozapine (Clozaril)
  • Risperidone (Risperdal)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)

Antiparkinson drugs, such as:

  • Benztropine (Cogentin)
  • Trihexyphenidyl (Artane)
  • Procyclidine (Arpicolin, Kemadrin)
  • Biperiden

Antihistamines, such as:

  • diphenhydramine (Benadryl)
  • chlorpheniramine (Chlor-Trimeton, Sinutab Sinus Allergy)

Antidepressants, especially tricyclics, such as:

  • Imipramine (Tofranil)
  • Amitriptyline (Elavil)
  • Nortriptyline (Pamelor)
  • Doxepin (Sinequan)
  • Desipramine (Norpramin)
  • Protriptyline (Vivactil)

Do:

  • Educate yourself about symptoms of heat stroke
  • Sleep in a cool place.
  • Drink extra fluids. Water is best because the body absorbs cooler solutions fast. Other fluids you can try include juice, Gatorade, and caffeine-free soda.
  • Increase salt intake if there are no medical contraindications.
  • If you take lithium, be sure to remain well-hydrated.
  • Spend time in cool places (shopping malls, movies, etc.)
  • Wear loose, light-colored, summer-weight clothing.
  • Use fans or air conditioning.
  • When feeling warm, use cool, wet compresses or sit in a tub of cool water.
  • Remain with another person.
  • Monitor loved ones and neighbors during a heat wave for signs of heat stroke

Don’t:

  • Engage in strenuous exercise in the heat.
  • Drink alcoholic beverages, coffee, and soda with caffeine (caffeine and alcohol increase water loss).
  • Spend excessive time outside in the sun.
  • Sleep or spend prolonged time in hot conditions.

Click here for more tips on preventing heat exhaustion and heat stroke.

Warning signs of heat stroke:

  • Nausea, headache, feeling poorly, weakness
  • Irritability, anxiety
  • Fast pulse, rapid breathing, dizziness
  • Hot OR dry skin, confusion, vomiting, diarrhea

The Centers For Disease Control & Prevention (CDC) provides additional information about heat stroke..

Aurora Behavioral Health Services offers complete mental health treatment options, provided by highly trained professionals in a caring, confidential manner to meet individual and family needs.  If you or someone you know needs help, contact us — online or by phone at 1-877-666-7223 — as soon as possible.

 

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