07.07.2021
In July, many regions are expected to be hot again. How to protect your health?
Nadezhda Runikhina , tells AiF about this .
Pressure surges
– Nadezhda Konstantinovna, how does the well-being of an elderly person change in very hot weather, what are the most dangerous symptoms?
– Heat is a serious test for the body of an elderly person, who, as a rule, has several diseases. First of all, the load on the cardiovascular system increases, the heart rate increases. But blood pressure can behave differently: for some it increases, for others it decreases. You need to regularly measure your blood pressure and take medications on time.
Dehydration, i.e. dehydration, is very dangerous. In the heat, the evaporation of moisture from the skin and mucous membranes increases, a person loses not only water, but also electrolytes - sodium, potassium, calcium salts in the blood . And you need to replenish fluid on time. However, older people may have problems with this. As many people age, their thirst becomes worse. There are patients who, due to a geriatric syndrome such as urinary incontinence , specifically try to limit their water intake. Others try to drink less to avoid excessive sweating . And a decrease in fluid in the body leads to a whole cascade of adverse reactions. In particular, the risk of thrombosis increases, as blood . And this, in turn, can lead to heart attack , stroke, deep vein thrombosis of the lower extremities - depending on in which vessels the blood clots have formed.
– Some older people complain of weakness and dizziness in the heat...
– This may also be a consequence of the fact that they do not drink enough fluids. Due to dehydration, orthostatic reactions develop. When the body position changes, blood pressure does not increase (as is normal), but, on the contrary, decreases significantly. brain worsens . As a result, dizziness , darkening of the eyes , a person may lose consciousness and fall, and be seriously injured. Brain damage can be more serious when acute cognitive impairment develops due to dehydration and overheating, delusions and hallucinations (delirium) appear. Such disorders are possible in very elderly people. It starts with the fact that a person simply becomes very inattentive. It would seem not scary. But in reality, since the brain controls all functions, this affects all the activities of the body.
HealthTrapped in the body: What really happens to people “in a coma”
Scott was involved in an accident in 1999, and scientists were able to establish contact with him only at the end of 2012. The fact is that twenty years ago such an experiment would have been impossible. “Locked-in syndrome” - when the patient is helpless but conscious - began to be studied relatively recently. One of the reasons is significant progress in medicine.
Fifty years ago, defibrillation was carried out mainly with medication and not always. If a person's heart stopped, he could be immediately declared dead and sent to the morgue. At the same time, the patient’s brain could well still remain alive - cell death in the cerebral cortex begins only three minutes after breathing stops. However, even if some of the cells have died, a person can still be brought back to life - although it is quite likely that he may remain in a vegetative state forever.
Due to the fact that people could be declared dead even before brain death, strange incidents occurred. Patients may suddenly recover from cardiac arrest. This is probably where the legends came from that some people were buried alive. Some people still suffer from taphophobia (fear of being buried alive) and ask to be buried so that if they suddenly awaken, they can escape from the grave or crypt.
In the 1950s, doctors began using electric defibrillators - now a person’s heart could be “restarted”, and this was done quite often. In addition, in the 50s, the world's first ventilator appeared in Denmark. From that moment on, the very concepts of life and death became quite vague. Intensive care units appeared in hospitals all over the world, where people were kept alive with the help of various devices. A “gray zone” appeared between life and death, and over time it became clear that it was heterogeneous.
“It was once believed that a person died if his heart stopped,” says Adrian Owen. - But if a patient has had an artificial heart transplanted, can we consider him dead? Another possible parameter is the ability to support one’s life activities independently. But then the person connected to the ventilator is dead? And the baby is dead a few days before it is born?” Answers to all these questions are quite difficult, says Owen. It is not even clear who should give them - doctors, philosophers or priests.
Meanwhile, in Europe alone, about two hundred and thirty thousand people fall into a coma every year. Of these, thirty thousand people remain in a vegetative state for a long time or forever. And if one of them is completely unable to respond to the influence of the outside world, then someone is aware of everything that is happening. If doctors learn to accurately determine whether a person with brain damage has retained consciousness, and if so, to what extent, this could change a lot. Relatives will understand whether a person needs the TV turned on and special care or whether he still does not understand anything. It will be easier for them to decide whether to turn off life support. Do doctors need to devote their efforts to trying to bring a person out of a vegetative state, or is his thinking ability lost forever? On the other hand, this will raise many new questions. For example, does a person want to be brought out of a vegetative state if they remain permanently paralyzed? If consciousness is still present in a person, is it not too oppressed for his subsequent life to be called full? And, in the end, what is considered consciousness?
Don't bring it to the emergency room
– Diabetes mellitus is a very common diagnosis in older people. What do they need to remember in hot weather?
– Yes, the most vulnerable among all patients are patients with metabolic syndrome. And diabetes mellitus is a prime example. Already initially, these patients have problems associated with the regulation of not only carbohydrate metabolism, but also protein and electrolyte metabolism. Sometimes they are overweight. Therefore, in hot conditions there may be higher blood , but what is even more dangerous are episodes of hypoglycemia in patients who are on insulin therapy. Hypoglycemic conditions can quickly lead to very serious complications. Therefore, it is more important than ever for such patients to more carefully monitor medications, insulin doses, and follow a diet with a reduced amount of simple carbohydrates.
– What could be the consequences of prolonged heat?
– Decreased functional status may occur. In hot weather, it is very difficult to maintain physical activity. Elderly people stay at home, sometimes in bed, and stop moving. This very quickly leads to the development of muscle weakness and functional deficits. You should definitely take a walk, for example, in the very early morning hours in a park, along the shore of a pond, or at least go out and just sit in the shade of trees or buildings.
Another danger is nutritional deficiency. Of course, in the heat, appetite decreases, but you can’t completely give up food. Juicy vegetables, fruits with a high liquid content, and fermented milk products (if there is no intolerance) are very useful.
Those who have very elderly relatives should pay closer attention to their hygiene and avoid diaper rash and abrasions on the skin of an elderly person. In the heat, infection of these tissues can occur very quickly.
– Is the number of visits to doctors from older patients increasing?
– In hot weather, the flow of elderly patients with heart attacks, strokes, and injuries increases (if a weakened elderly person falls, the injury may be incompatible with life). There are especially dangerous outcomes among people with many chronic diseases, diabetes mellitus .
On hot days , as a rule, there are not many calls the clinic It is often difficult for an elderly person to get organized, come and see a doctor in the heat. And that's the problem. As a result, there are emergency calls - heart attack , stroke, falls, trauma, hypertensive crisis. For example, in Germany it was calculated that in hot weather, every third reason for hospitalization in geriatric patients is associated with dehydration (the first two are cardiovascular diseases and injuries). It is dehydration that causes emergency hospitalization. While the problem can be solved very simply: control the amount of water you drink. It is no coincidence that in medical institutions, especially in geriatric departments, medical staff walk through the rooms with water an additional 2-3 times a day and ask patients to drink more. Therefore, in the family, relatives should pay more attention not only to what pills the elderly person has taken, but also to whether he drinks enough water.
Diabetic coma - symptoms and treatment
The basis for the development of hypoglycemic coma is a decrease in the level of glucose entering the cells of the central nervous system. This leads to the development of energy deficiency, oxygen “hunger”.
The first brain reactions to hypoglycemia occur when glucose drops to 3.8 mmol/l. As sugar levels fall, various parts of the brain are affected: first, the cortex is affected, then the functioning of the subcortical structures and cerebellum is disrupted, which causes symptoms of hypoglycemia (impaired coordination, headache, confusion of speech, etc.). The medulla oblongata is the last to be affected, which is the cause of death.
Simultaneously with a decrease in glycemia and damage to brain structures, the counterinsular systems are activated: the pituitary gland, pancreas and adrenal glands. They begin to actively produce counter-regulatory hormones to increase glucose production. These hormones include glucagon, cortisol, growth hormone, adrenaline and norepinephrine. However, in a person with diabetes mellitus, this reaction is impaired, and therefore the patient experiences tachycardia, sweating and other clinical manifestations [1][7][10].
The development of diabetic ketoacidosis , which precedes ketoacidotic coma , begins with insulin deficiency, due to which the following changes occur:
- the concentration of glucose in the blood increases due to a decrease in its entry into liver cells and muscles;
- additional glucose synthesis occurs due to an increase in the level of counter-insular hormones;
- cells begin to “starve” because glucose does not enter them;
- protein breakdown occurs, which tries to provide hungry cells with glucose;
- fat reserves are broken down and free fatty acids are formed;
- oxidation of fatty acids leads to ketosis - the formation of ketone bodies in the liver, which lead to an imbalance in the acid-base balance of the blood (and fats that come from food do not participate in the formation of ketone bodies).
Since a lot of glucose accumulates in the blood, it begins to be excreted along with urine and at the same time pulls water with it, which leads to dehydration. As a result of a high concentration of ketone bodies, the patient experiences vomiting and even greater dehydration. All this leads to hypovolemic circulatory failure (due to a decrease in circulating blood volume) and tissue hypoxia. The kidneys and myocardium (heart muscle) are damaged, the blood vessels dilate, and then consciousness is impaired [8][9][10].
The pathogenesis of hyperosmolar hyperglycemic coma is not completely clear. It is known that it is characterized by an increase in blood glucose and osmolarity (the concentration of its active elements, in particular electrolytes) on an empty stomach. In this case, manifestations of ketosis and acidosis do not occur. In cases of relative insulin deficiency (i.e., type 2 diabetes), the increase in glycemia and osmolarity is not sufficient to break down adipose tissue and form ketone bodies, but the body cannot suppress the production of glucose by the liver.
Plasma hyperosmolarity is maintained by glucose and sodium, compounds with high concentrations of electrolytes. They do not penetrate well into the cell and, remaining outside, attract water to themselves, thereby dehydrating the cells. The same processes occur in the brain, which leads to dehydration (dehydration) and loss of consciousness, and as a result of hypoxia, vital organs are damaged: kidneys, lungs, heart, etc. [1][2][5].
The main mechanism for the development of lactic acidotic coma is tissue hypoxia. Against this background, the anaerobic (oxygen-free) pathway of glycolysis is launched - the breakdown of glucose into lactic acid molecules (lactate). Under conditions of hypoxia, the conversion of lactate into glycogen is inhibited in the liver. This leads to the fact that lactate is not utilized, but accumulates. As a result, lactic acid provokes a shift in the acid-base state towards acidosis (increased acidity). And since lactate has a toxic effect, the patient develops weakness, nausea and other symptoms, even coma [1][2][4].
Advice from Dr. Runikhina
- Carefully monitor how much fluid you drink. For those who live alone and are not confident in their memory, you can use the same principle as with medicines that are put in a pill box for the day: in the morning, pour water into a 1.5-2 liter bottle or carafe, put it on the table and drink during the day. It is important to drink not only water - fruit drinks, compotes, mineral water, tea are suitable.
- The best diet in the heat is a light dairy-vegetable diet. Vegetables, fruits, all kinds of smoothies, dairy products, low-fat kefir or kefir diluted with water, low-fat cottage cheese. This will provide the body with vitamins, minerals, fiber and protein. It is better to eat little by little and have small snacks more often.
- Reduce physical activity. Don't even try to work in the garden. However, you cannot lie down all day. You need to get up and walk. You can go outside and sit or take a walk in the shade, in a park, next to a fountain or pond.
- You should not swim in open water in hot weather. Due to the large difference in air and water temperatures, there is a risk of developing vasospasm and , as a result, a heart attack.
- Elderly people should be careful in the open sun - only wear a hat, be sure to use sunglasses, and cover exposed skin with light-colored clothing. The risk of skin damage and the development of cancer under the influence of ultraviolet radiation in older people is very high.
- Take water treatments at home as often as possible. This will refresh and prevent skin diseases.
When to see a doctor immediately
- In case of a fall, even if there is no visible damage or injury.
- If there is chest pain, shortness of breath.
- If there is asymmetrical weakness in the arms and legs , it is difficult for you to speak, speech has become slurred and unintelligible.
- If a person behaves differently than usual: he becomes very sleepy, starts talking, repeats the same thing (possible symptoms of brain ).
- Nausea and vomiting do not go away
