|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|
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.