Highlights & Basics
- Heat stroke is generally associated with core temperatures >104°F (>40°C).
- Diagnosis rests on the observation of profound central nervous system dysfunction in the presence of hyperthermia.
- Drugs may predispose patients to heat stroke (e.g., diuretics, antihypertensives).
- Early cooling reduces mortality and morbidity, and should be initiated as soon as possible.
- Evaporation and ice water immersion are both widely used as cooling methods.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Eifling KP, Gaudio FG, Dumke C, et al. Wilderness Medical Society clinical practice guidelines for the prevention and treatment of heat illness: 2024 update. Wilderness Environ Med. 2024 Mar;35(1 suppl):112S-27S.[Abstract][Full Text]
Roberts WO, Armstrong LE, Sawka MN, et al. ACSM expert consensus statement on exertional heat illness: recognition, management, and return to activity. Curr Sports Med Rep. 2023 Apr 1;22(4):134-49.[Abstract][Full Text]
Gauer R, Meyers BK. Heat-related illnesses. Am Fam Physician. 2019 Apr 15;99(8):482-9.[Abstract][Full Text]
1. Glazer JL. Management of heatstroke and heat exhaustion. Am Fam Physician. 2005 Jun 1;71(11):2133-40.[Abstract][Full Text]
2. Epstein Y, Yanovich R. Heatstroke. N Engl J Med. 2019 Jun 20;380(25):2449-59.[Abstract][Full Text]
3. Adelakun A, Schwartz E, Blais L. Occupational heat exposure. Appl Occup Environ Hyg. 1999 Mar;14(3):153-4.[Abstract]
4. Jones TS, Liang AP, Kilbourne EM, et al. Morbidity and mortality associated with the July 1980 heat wave in St. Louis and Kansas City, Mo. JAMA. 1982 Jun 25;247(24):3327-31.[Abstract]
5. Centers for Disease Control and Prevention. Heat-related illness and deaths-United States, 1994-1995. MMWR Morb Mortal Wkly Rep. 1995 Jun 30;44(25):465-8.[Abstract][Full Text]
6. Shah DA, Najib T. Heat stroke in Karachi: An unprecedented medical emergency. J Infect Public Health. 2016 May-Jun;9(3):370-1.[Abstract][Full Text]
7. Hoag H. How cities can beat the heat. Nature. 2015 Aug 27;524(7566):402-4.[Abstract]
8. Council on Sports Medicine and Fitness and Council on School Health; Bergeron MF, Devore C, et al. Policy statement - Climatic heat stress and exercising children and adolescents. Pediatrics. 2011 Sep;128(3):e741-7.[Abstract][Full Text]
9. Bynum GD, Pandolf KB, Schuette WH, et al. Induced hyperthermia in sedated humans and the concept of critical thermal maximum. Am J Physiol. 1978 Nov;235(5):R228-36.[Abstract]
10. Gathiram P, Wells MT, Brock-Utne JG, et al. Antilipopolysaccharide improves survival in primates subjected to heat stroke. Circ Shock. 1987;23(3):157-64.[Abstract]
11. Leon LR, Helwig BG. Heat stroke: role of the systemic inflammatory response. J Appl Physiol. 2010 Dec;109(6):1980-8.[Abstract][Full Text]
12. Bouchama A, Dehbi M, Mohamed G, et al. Prognostic factors in heat wave-related deaths. Arch Intern Med. 2007 Nov 12;167(20):2170-6.[Abstract][Full Text]
13. Nakai S, Itoh T, Morimoto T. Deaths from heat stroke in Japan: 1968-1994. Int J Biometerol. 1999 Nov;43(3):124-7.[Abstract]
14. Semenza JC, Rubin CH, Falter KH, et al. Heat-related deaths during the July 1995 heat wave in Chicago. N Engl J Med. 1996 Jul 11;335(2):84-90.[Abstract][Full Text]
15. Kilbourne EM, Choi K, Jones S, et al. Risk factors for heatstroke: a case-control study. JAMA 1982 Jun 25;247(24):3332-6.[Abstract]
16. Kellerman AL, Todd KH. Killing heat. N Engl J Med. 1996 Jul 11;335(2):126-7.[Abstract]
17. Casa DJ, Becker SM, Ganio MS, et al. Validity of devices that assess body temperature during outdoor exercise in the heat. J Athl Train. 2007 Jul-Sep;42(3):333-42.[Abstract][Full Text]
18. Eifling KP, Gaudio FG, Dumke C, et al. Wilderness Medical Society clinical practice guidelines for the prevention and treatment of heat illness: 2024 update. Wilderness Environ Med. 2024 Mar;35(1 suppl):112S-27S.[Abstract][Full Text]
19. Bennett BL, Hew-Butler T, Rosner MH, et al. Wilderness Medical Society clinical practice guidelines for the management of exercise-associated hyponatremia: 2019 update. Wilderness Environ Med. 2020 Mar;31(1):50-62.[Abstract][Full Text]
20. Nadesan K, Kumari C, Afiq M. Dancing to death: a case of heat stroke. J Forensic Leg Med. 2017 Aug:50:1-5.[Abstract]
21. Bedno SA, Li Y, Han W, et al. Exertional heat illness among overweight US Army recruits in basic training. Aviat Space Environ Med. 2010 Feb;81(2):107-11.[Abstract]
22. Bouchama A, Bridey F, Hammami MM, et al. Activation of coagulation and fibrinolysis in heatstroke. Thromb Haemost. 1996 Dec;76(6):909-15.[Abstract]
23. Tam N, Noakes TD. The quantification of body fluid allostasis during exercise. Sports Med. 2013 Dec;43(12):1289-99.[Abstract]
24. McGee S, Abernethy WB 3rd, Simel DL. The rational clinical examination. Is this patient hypovolemic? JAMA. 1999 Mar 17;281(11):1022-9.[Abstract]
25. Roberts WO, Armstrong LE, Sawka MN, et al. ACSM expert consensus statement on exertional heat illness: recognition, management, and return to activity. Curr Sports Med Rep. 2023 Apr 1;22(4):134-49.[Abstract][Full Text]
26. Armstrong LE, De Luca JP, Hubbard RW. Time course of recovery and heat acclimation ability of prior exertional heatstroke patients. Med Sci Sports Exerc. 1990 Feb;22(1):36-48.[Abstract]
27. Hausfater P, Mégarbane B, Fabricatore L, et al. Serum sodium abnormalities during nonexertional heatstroke: incidence and prognostic values. Am J Emerg Med. 2012 Jun;30(5):741-8.[Abstract]
28. Tuchschmidt J, Oblitas D, Fried JC. Oxygen consumption in sepsis and septic shock. Crit Care Med. 1991 May;19(5):664-71.[Abstract]
29. Deshpande GG, Heidemann SM, Sarnaik AP. Heat stress is associated with decreased lactic acidemia in rat sepsis. Crit Care. 2000;4(1):45-9.[Abstract][Full Text]
30. Bouchama A, Knochel JP. Heat stroke. N Engl J Med. 2002 Jun 20;346(25):1978-88.[Abstract]
31. Hassanein T, Razack A, Gavaler JS, et al. Heatstroke: its clinical and pathological presentation, with particular attention to the liver. Am J Gastroenterol. 1992 Oct;87(10):1382-9.[Abstract]
32. Gauer R, Meyers BK. Heat-related illnesses. Am Fam Physician. 2019 Apr 15;99(8):482-9.[Abstract][Full Text]
33. Bouchama A, Dehbi M, Chaves-Carballo E. Cooling and hemodynamic management in heatstroke: practical recommendations. Crit Care. 2007;11(3):R54.[Abstract][Full Text]
34. Harker J, Gibson P. Heat-stroke: a review of rapid cooling techniques. Intensive Crit Care Nurs. 1995 Aug;11(4):198-202.[Abstract]
35. Hadad E, Rav-Acha M, Heled Y, et al. Heat stroke: a review of cooling methods. Sports Med. 2004;34(8):501-11.[Abstract]
36. Newport M, Grayson A. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: In patients with heatstroke is whole-body ice-water immersion the best cooling method? Emerg Med J. 2012 Oct;29(10):855-6.[Abstract]
37. McDermott BP, Casa DJ, Ganio MS, et al. Acute whole-body cooling for exercise-induced hyperthermia: a systematic review. J Athl Train. 2009 Jan-Feb;44(1):84-93.[Abstract][Full Text]
38. Casa DJ, DeMartini JK, Bergeron MF, et al. National Athletic Trainers' Association position statement: exertional heat illnesses. J Athl Train. 2015 Sep;50(9):986-1000.[Abstract][Full Text]
39. Miller KC, Long BC, Edwards J. Necessity of removing American football uniforms from humans with hyperthermia before cold-water immersion. J Athl Train. 2015 Dec;50(12):1240-6.[Abstract][Full Text]
40. Gagnon D, Lemire BB, Casa DJ, et al. Cold-water immersion and the treatment of hyperthermia: using 38.6°C as a safe rectal temperature cooling limit. J Athl Train. 2010 Sep-Oct;45(5):439-44.[Abstract][Full Text]
41. Hong JY, Lai YC, Chang CY, et al. Successful treatment of severe heatstroke with therapeutic hypothermia by a noninvasive external cooling system. Ann Emerg Med. 2012 Jun;59(6):491-3.[Abstract]
42. Newsham KR, Saunders JE, Nordin ES. Comparison of rectal and tympanic thermometry during exercise. South Med J. 2002 Aug;95(8):804-10.[Abstract]
43. Bursey MM, Galer M, Oh RC, et al. Successful management of severe exertional heat stroke with endovascular cooling after failure of standard cooling measures. J Emerg Med. 2019 Aug;57(2):e53-6.[Abstract][Full Text]
44. Raj VM, Alladin A, Pfeiffer B, et al. Therapeutic plasma exchange in the treatment of exertional heat stroke and multiorgan failure. Pediatr Nephrol. 2013 Jun;28(6):971-4.[Abstract]
45. Bouchama A, Cafege A, Devol EB, et al. Ineffectiveness of dantrolene sodium in the treatment of heatstroke. Crit Care Med. 1991 Feb;19(2):176-80.[Abstract]
46. Varghese GM, John G, Thomas K, et al. Predictors of multi-organ dysfunction in heatstroke. Emerg Med J. 2005 Mar;22(3):185-7.[Abstract][Full Text]
47. Yamamoto T, Fujita M, Oda Y, et al. Evaluation of a novel classification of heat-related illnesses: a multicentre observational study (Heat Stroke STUDY 2012). Int J Environ Res Public Health. 2018 Sep 8;15(9):1962.[Abstract][Full Text]
48. Epstein Y. Heat intolerance: predisposing factor or residual injury? Med Sci Sports Exerc. 1990 Feb;22(1):29-35.[Abstract]
49. Johnson EC, Kolkhorst FW, Richburg A, et al. Specific exercise heat stress protocol for a triathlete's return from exertional heat stroke. Curr Sports Med Rep. 2013 Mar-Apr;12(2):106-9.[Abstract]
50. Druyan A, Makranz C, Moran D, et al. Heat tolerance in women - reconsidering the criteria. Aviat Space Environ Med. 2012 Jan;83(1):58-60.[Abstract]
51. Wang JC, Chien WC, Chu P, et al. The association between heat stroke and subsequent cardiovascular diseases. PLoS One. 2019 Feb 13;14(2):e0211386.[Abstract][Full Text]
