| Temperature (core) | Presentation | Management | |
| Miliaria Crystallina | Normal | Salt-colored tiny papules, easily burst; not pruritic | Modify environment; light clothing; hydration |
| Miliaria Rubra | Normal | Discrimiate, red papules, not assocaited with follicles; pruritic | Above plus cool compresses; calamine lotion; symptomatic tx for pruritis |
| Miliaria Profunda | Normal | Confluent flesh-colored, "lumpy-bumpy"; burning | Same as rubra |
| Miliaria Pustulosa | Normal | May resemble rubra and/or crustallina, but pustular; h/o previous dermatitis | Same as above, but may may need antibiotic if no improvement over time |
| Heat edema | Normal | Swelling of feet, ankles, and/or lower legs | Modify environment; elevate legs |
| Heat syncope | Normal | Dizziness, orthostatic hypotension, and syncope after exertion with rapid return to normal mental status when supine | Modify environment; rehydration; monitoring |
| Heat cramps | May be elevated to 40°C (104°F) | Exercise-induced cramping in large muscle groups, especially legs | Hydration; consider labs (Cr, total CK); may counsel to stretch muscles passively, gently |
| Heat tetany | May be elevated to 40°C (104°F) | Hyperventilation with paresthesia, carpopedal spasm | Modify environment; hydration; may place non-rebreather mask on low (or off) for rebreathing CO2 |
| Heat exhaustion | Elevated up to 40°C (104°F) | Normal mental status, fatigue, that rapidly improves with treatment; tachycardia; GI symptoms; electrolyte abnormalities | Cool environment; hydration; consider labs with severe symptoms, or if not improved |
| Heat Stroke | >40 to 40.5°C (104 to 105°F) | Altered mental status; tachypneic; tachycardic with hypotension; electrolyte abnormalities; GI symptoms; often with renal failure, rhabdomyloysis, renal failure; possibly with cardiogenic shock or ARDS or DIC | Rapid cooling with all modalities available (radiation, conduction, convection, evaporation); IV rehydration; labs; monitoring; ICU admission |
Selected References
Bergeron MF, Devore C, et al. Council on Sports Medicine and Fitness and Council on School Health, Policy statement—Climatic heat stress and exercising children and adolescents. Pediatrics 2011; 128:e741.
Casa DJ et al. The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best-Practices Recommendations. J Athl Train. 2013 Jul-Aug; 48(4): 546–553.
DeFranco MJ et al. Environmental issues for team physicians. Am J Sports Med. 2008 Nov;36(11):2226-37.
Ishimine P. Hyperthermia. In: Pediatric Emergency Medicine, Baren JM, Rothrock SG, Brennan JA, Brown L (Eds), Saunders Elsevier, Philadelphia 2008. p.992.
Jardine DS. Heat illness and heat stroke. Pediatr Rev 2007; 28:249.