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Abstract: A 35-year-old patient was admitted to our hospital by 120. After understanding, the patient suddenly developed general numbness and convulsions while working outdoors, which could not be relieved after rest, was conscious, did not show symptoms of urinary or fecal incontinence, and improved slightly after being transferred to an air-conditioned room. The patient was admitted to the hospital for general examination, the body temperature was 36℃, general numbness and convulsions were still present, other auxiliary examinations did not show any obvious abnormality, so the diagnosis was heat cramps, and the uncomfortable symptoms disappeared after giving medication.
Basic information】Male, 35 years old
Disease Type】Spasm (heat spasm)
Hospital】Beijing Tiantan Hospital
Date of consultation】August 2021
Treatment plan】Intravenous drip (acetylglutamine injection, glucose injection) + oral medication (pantoprazole sodium enteric capsule, huo xiang zheng qi water)
[Treatment period] Hospitalization for 4 days
Treatment effect】Discomfortable symptoms disappeared and liver function returned to normal
I. Initial consultation
A 35-year-old patient was admitted to our hospital by 120. When we first saw the patient, the patient had numbness and convulsions all over the body. After understanding, the patient suddenly developed symptoms such as generalized numbness and convulsions while working outdoors, which could not be relieved after rest, but did not show symptoms of dizziness, headache, nausea or vomiting. When the symptoms appeared, the patient was conscious and did not show symptoms of urinary or fecal incontinence. After transferring to an air-conditioned room, the patient improved slightly and was picked up by 120 and brought to our hospital. General examination of the patient revealed that general numbness and convulsions were still present. When asked about his past history, the patient denied any history of hypertension, coronary heart disease, diabetes mellitus, no history of surgery or trauma, no history of smoking or alcohol abuse, and no history of drug allergy. Based on the above clinical manifestations, the patient was initially suspected to have heat cramps, so he was given patchouli water for oral administration, and his symptoms were relieved after taking it.
II. Treatment history
The patient was given further monitoring of vital signs. The current body temperature was 36.8℃, heart rate was 80 beats/min, respiration was 18 breaths/min, blood pressure was 124/95mmHg, and there were no obvious abnormalities. Examination of EEG, renal function, cardiac enzymes, blood coagulation, and electrolytes showed no significant abnormalities. Liver function suggested mild elevation of total bilirubin, but the patient had no symptoms of oil aversion or abdominal pain, so liver injury was discharged. An electrocardiogram was performed and the results returned sinus rhythm, and no significant abnormalities were seen in the cranial and chest CT. Based on the patient’s symptoms and ancillary findings, the diagnosis was heat cramps. Therefore, the patient was given oral pantoprazole sodium enteric capsules to protect the gastric mucosa, intravenous acetylglutamine injection to improve cerebral metabolism, and glucose injection for rehydration.
III. Treatment effect
On the second day of drug treatment, the patient reported soreness in the muscles of both lower limbs, but the symptoms of generalized convulsions and numbness were relieved compared with those before treatment, the body temperature was in the normal range, no symptoms of chest tightness and shortness of breath, and the appetite and rest were better. The repeat examination of blood routine, urine routine, stool routine and liver function did not show any obvious abnormality, but the liver function still indicated high total bilirubin. On the third day of treatment, the patient reported that the pain in both lower limbs had decreased after rest, but he was still unable to walk for a long time. On the fourth day of treatment, the patient’s numbness and muscle pain disappeared, and the total bilirubin of liver function returned to normal, and the discharge criteria were met.
IV. Notes
We are glad that the patient’s discomfort symptoms were relieved after treatment, but since the patient in this article developed symptoms while working outdoors, the patient still needs to pay attention to the following points after discharge.
1. minimizing long hours of work in a hot environment during normal times, paying attention to rest, preparing ice water to cool down, as well as the preventive use of patchouli.
2, need to pay attention to hydration when working, you can add a small amount of salt to the water, or directly drink functional drinks to maintain the body’s salt, water, and mineral content to prevent the emergence of adverse symptoms.
3. In terms of diet, patients are advised to eat more water-rich fruits and vegetables to keep their bodies well hydrated. If working under high temperature is unavoidable, it is recommended to increase exercise in general to improve the body immunity.
V. Personal insight
In this case, the patient’s heat cramps led to a disorder of electrolyte metabolism in the body, which in turn led to muscle spasms of the limbs, etc. After treatment, the patient had convulsive symptoms, but due to the long duration of symptoms appeared lactic acid accumulation, resulting in muscle pain. The patient’s elevated total bilirubin may be a transient liver injury that returns to normal after treatment.
Heat cramps are more common in everyday life and usually have a good prognosis if treated promptly. If someone is found to have heat cramps, the patient is quickly given cooling measures to remove the patient from the hot environment, either by using ice water or ice cubes to cool them down, or by moving them to an air-conditioned room and giving them patchouli water in a timely manner, which can effectively relieve the patient’s symptoms.