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LETTERS: William R Keatinge Author's reply to letters on death in heat waves BMJ 2004; 328: 50-a [Full text]

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How much did you drink?

Tom H Hughes-Davies   (7 January 2004)

How much did you drink? 7 January 2004
Tom H Hughes-Davies, Retired paediatrician Breamore Marsh Send response to journal: Re: How much did you drink?	In his interesting review of deaths in heat waves, Professor Keatinge mentions drinking but does not emphasise its importance. When water is lost and not fully replaced blood volume falls and blood concentration rises. Though extravascular water is drawn in this may not enough. Vascular volume must equal blood volume and parts of the circulation must then diminish. This may lead to panting from an accelerating metabolic acidaemia, and to a fall in skin circulation with a rising central temperature. Ultimately falling circulation and increasing haemoconcentration may cause many organs to fail. The picture is very similar in severe diarrhoea in children and sudden collapse in the elderly with pneumonia, who need rapid replacement of volume by electrolyte solution to make up for what they should have drunk earlier. It would be interesting to ask all admitted in a heat wave how much they have drunk, and to check the colour and quantity of their urine. In subtropical slums death varies less with exposure to heat than with the presence of some one to give an old lady a drink. Competing interests: None declared