Heat Stroke and Hyperosmolar Hyperglycemia State: Two Faces of the Same Coin (Dehydration) in the Hajj Journey - How to Reduce Deaths Among Pilgrims

Heat stroke (HS) and hyperosmolar hyperglycemic state (HHS) are critical conditions frequently affecting pilgrims during the Hajj, especially with temperatures exceeding 50°C (122°F). This brief commentary examines the interconnected risks of HS and HHS among Hajj pilgrims, focusing on the heightened vulnerability of those with diabetes. We discuss the mechanisms linking dehydration, hyperthermia, and hyperglycemia, emphasizing the need for early recognition and intervention. Preventive strategies such as heat acclimation, proper hydration, and probiotic-based oral rehydration solutions (ORSP) are highlighted. Additionally, the use of smart ID medical bracelets for diabetic patients can improve emergency response. Implementing these measures can reduce the incidence and severity of heat stroke and hyperosmolar hyperglycemic state, protecting the health of pilgrims.