This is a self-limited process manifested by mild swelling and tightening of the hands and feet that appears within the first few days of exposure to a hot environment. Heat edema is due to cutaneous vasodilatation and orthostatic pooling of interstitial fluid in the extremities. Some authorities feel increased secretion of aldosterone and antidiuretic hormone also plays a role. It is found most commonly in elderly nonacclimatized individuals who are physically active after a prolonged period of sitting in a car, bus, or plane. To a lesser extent, it is seen in healthy travelers just arriving from a colder climate. Edema is usually mild and does not restrict normal activities. Rarely, pitting edema of the ankles may develop, but heat edema does not progress to the pretibial region. A typical history and thorough physical examination are sufficient to exclude systemic causes of edema. Heat edema usually resolves spontaneously in a few days but may take up to 6 weeks. No special treatment is necessary. If a patient is insistent on treatment, elevation of the legs and the use of support hose will facilitate the removal of the interstitial fluid. Diuretics are not effective and can predispose patients to electrolyte abnormalities, volume depletion, or a more serious heat illness.
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