My heat exhaustion story happened when I was about 40 (that was 30 years ago).



I went off on a 70 mile loop from Lakeport, CA with a half gallon of water and a quart of lemonade in late summer. There were a couple stream crossings I hoped to refill from. The tracks were mostly dirt forest roads. The day was warm; probably got up to 90 degrees. It was great riding but mostly exposed and the streams were dry. I plodded on after running out of water and lemonade. The area was remote and without places where I could ask for water. Late in the day as I was climbing Bartlett springs road and I felt quite weak. My legs would start to cramp and I would have to get off the bike and just lie in the dirt. This happened several times as I worked my way up the road to the summit. I would ride 200 yards, get off or fall off, rest until the cramp stopped, get on the bike again, ride another 200 yards, fall off the during a cramp etc, etc. There was no traffic to flag a ride from, at all.



At that point, I was not even thirsty. My gut had shut down and the idea of drinking water did not sound good; I would just throw it up. Finally I reached the summit where it was all downhill into the small town of Nice. I managed to get down the hill and stopped at the first place I saw which was a bar. There was a soda vending machine outside. I thought maybe I could manage to drink a Coke. I put the money in, but the machine would not give me the Coke. So I just lay down in the dirt, utterly exhausted. A drunk fellow staggered out of the bar and asked about my condition and wished me luck. I saw a pay phone outside so I got up and called my wife. She drove the 12 miles to save me and I threw up in the car on the way back home.



As a paramedic, I should have been more cautious about managing my hydration. I rested at home and tried to drink water with some salt in it, but just couldn’t. My body was saving the limited blood supply remaining for my heart and brain. The gut was getting almost nothing, which made me feel nauseated. My pulse rate was around 120 (normally is 50 or in the 40s) at rest. I think I lost almost half of my circulating fluid volume (normal is 4 to 5 liters). What I needed was a couple liters of normal saline intraveneously to replace what I had lost. An IV would bypass the gut, which was in no condition to absorb anything.



I worked on the ambulance in San Francisco. If I could go to work and give myself an IV and dump 2 liters into my body I knew I would be okay. But that was a 2 1/2 hour drive away. So after 2 hours of trying to orally rehydrate and failing, we went to our local small town ER.



My habit from work was to enter the ER ambulance bay where the paramedics enter, and thats what I did absentmindedly. They were confused about that, but I gave them a paramedics summary of my condition. A nurse took my vitals which were normal except for the 118 heart rate. I told her my resting rate was normally about 50, but she was used to lots of people being mildly tachycardic, from fever, pain, or just being in a hospital. We were sent to a mostly empty waiting room for an hour. Later we learned that the doctor was taking a nap and they did not want to disturb him.



Finally I got to see the doc. He said we will do some basic blood testing (okay fine), and we will administer IV normal saline (yes please!). Soon I had my IV. The nurse set it on fast dribble, but when she left I opened it up wide. Soon the bag was almost empty and I called her in to give me another. After 2 liters I felt pretty good. I could drink water and I felt a slight urge to pee, something I hadn’t felt in about 18 hours.



That event was a window into a dehydration experience that many of my patients had. Since then, I have been much more careful in my hydration and had an increased awareness of it in my patient interactions.