Question: Hello doctor. My name is XXXXXXX and I am a 24 year old male. My question os regarding heat exhuastion, and possible heat stroke. I know i have written quite alot here, and i apologize for this. Please be patient, and consider apl that I have wrote, as i am very worried. Im extremely concered that i may have been affected by possible heat stroke or heat exhaustion. This saterday, on 6/11, I was driving for a total of 45 minutes in my car. Ir was around 101 or 102 degrees outside, as I live in Arizona. I was not using the air conditioning, but I had all of my windows rolled completely down. My sunroof was also open, allowing sun to shine into the car on my head. I was driving at high speeds on the highway at around 70 miles per hour consistently, so I was getting a good breeze. All morning that day, i havent drank any water, but i was not thirsty. I felt great while I was driving, but about 35 minutes into the drive, i started to feel sleepy, lightheaded, and dizzy. 10 minutes later, I went and got cold water, and got into an air conditioned building. I immediately felt better. No nausea, no mental changes, no flushed skin, and my exhaustion subsided.

I drank 2 liters of water, and ate a big meal after i went into the air conditioning, and stayed in the air conditioning for a total of 3 hours. I felt very good. The sun then started to subside, and the temperature outside went down to 99 degrees. I then drove back home another 45 minutes when the sun set a little bit more, and i felt much better, but towards the end of my drive, i started to feel very sleepy again, but that was it, nothing serious. When i got home, i felt very sleepy, and i just relaxed for a while. But again, no nausea, no mental changes, no flushed skin. I had a deep sleep that night, and the next day i felt good.

My worry is that i may have had one or multiple cases of heat exhaustion or heat stroke. I know it can cause permanent brain damage, as well as kidney, liver, and heart damage very quickly. I am scared that i may have damaged myself, and i do not know who to seek for help or if it is too late to determine a diagnosis. Today is now Tuesday 6/14, and i feel pretty ok, but I am worried i waited to long to get doagnosed, and they will no longer be able to tell if i suffered from either heat exhaustion or heat stroke. Should i make an appointment with a family doctor a week from now? Should I go to urgent care? Or should i just immediately go to the ER? Below I have listed the tests that are commonly done for diagnosing heat stroke, and most of them are dependent on levels inside the body and blood. For example, testing for, potassium levels, arterial gas testing, lactic acidosis, rhabdomyolysis, glucose levels, sodium levels, complete red blood cell count, hepatic tests, and MRI for organ damage. Did i wait too long? Would many of those levels have disappeared by now, effectively ruining the chances of effective diagnosis? If it is not too late, what kind of practioner should I see for this, and which levels could i still screen for? Should i go to ER instead? Below are common tests that are done. Thank you

Arterial blood gas testing

Arterial blood gas analysis may reveal respiratory alkalosis due to direct central nervous system (CNS) stimulation and metabolic acidosis due to lactic acidosis. Hypoxia may be due to pulmonary atelectasis, aspiration pneumonitis, or pulmonary edema.

Lactic acidosis

Lactic acidosis commonly occurs following exertional heatstroke (EHS) but may signal a poor prognosis in patients with classic heatstroke.

Glucose

Hypoglycemia may occur in patients with EHS and in patients with fulminant hepatic failure.

Electrolytes

Sodium

Hypernatremia due to reduced fluid intake and dehydration commonly is observed early in the course of disease but may be due to diabetes insipidus. Hyponatremia is observed in patients using hypotonic solutions, such as free water, and in patients using diuretics. It also may be due to excessive sweat sodium losses.

Potassium

Hypokalemia is common in the early phases of heatstroke, and deficits of 500 mEq are not unusual. However, with increasing muscle damage, hyperkalemia may be observed.

Other

Hypophosphatemia secondary to phosphaturia and hyperphosphatemia secondary to rhabdomyolysis, hypocalcemia secondary to increased calcium binding in damaged muscle, and hypomagnesemia also are observed commonly.

Complete blood cell count

Elevated white blood cell counts commonly are observed in patients with heatstroke, and levels as high as 40,000/μ L have been reported. Platelet levels may be low.

Hepatic Function Tests

Aminotransferase (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) llevels commonly rise to the tens of thousands during the early phases of heatstroke and peak at 48 hours, but they may take as long as 2 weeks to peak

Muscle Function Tests

Creatinine kinase (CK), lactate dehydrogenase (LDH), aldolase, and myoglobin commonly are released from muscles when muscle necrosis occurs.

CK levels exceeding 100,000 IU/mL are common in patients with EHS.

Elevations in myoglobin may not be noted despite muscle necrosis because myoglobin is metabolized rapidly by the liver and excreted rapidly by the kidneys.

Dr. Panagiotis! You must be Greek yeah? We're similar, I'm Romanian. Greeks have the best music, Vasilis Karras is my favorite. Anyways my friend, im getting off topic. Ok, so are any of these tests that you recomended time sensitive? Should i get them done as quick as possible? Meaning, if i wait too long, will any of these levels that i need to check for in my urine or blood be no longer detectable? Also, should i be fasting before I do these tests so that they are accurate?, or should i refrain from eating anything specific? Thank you my friend