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Heat Stroke

Published on January 28, 2026

by nusamedica

Man shielding eyes from the sun while holding a water bottle under intense sunlight – heat stroke prevention awareness.

Outdoor and indoor workers exposed to extreme heat or work in hot environments may be at risk for experiencing heat related illnesses. It occurs when the body’s cooling system is completely overwhelmed and stops working. Heat stroke is a life-threatening emergency. Heat stroke can cause permanent disability or death if the person does not receive emergency treatment.

Heat stroke as a condition in which the body experiences a drastic increase in temperature to 40°C or even higher. Exposure to heat does not only come from the weather or the sun, but can also occur in high-temperature work environments, such as restaurant kitchens, factories, or construction sites.

Classification of Heat stroke :

Exertional Heat Stroke (EHS).

Occurs due to intense physical activity in hot environments, often in:

Athletes.
Soldiers.
Construction workers.
Farmers, field workers.

Classic ( Non-Exertional ) Heat Stroke ( CHS ).

Occurs from exposure to environmental heat without strenuous activity, usually affecting:

The elderly.
Young children.
People with chronic illnesses.
People living in uncooled environments during extreme heat.

Pathophysiology of Heat stroke :

Heat stroke occurs when heat production exceeds the body's ability to dissipate it. The process includes :

Thermoregulatory failure.

Peripheral vasodilation.
Increased sweat production.
Dehydration → reduced evaporation.
Inability to maintain core temperature.

Cellular Damage Due to Heat.

Excessive heat causes :

Protein denaturation.
Cell membrane dysfunction.
Mitochondrial damage.
Apoptosis and tissue necrosis.

3. Systemic inflammatory response.

Heat stroke triggers processes such as systemic inflammatory response syndrome (SIRS) which can lead to :

Coagulopathy.
Rhabdomyolysis.
Acute kidney injury (AKI).
ARDS.
Multiple organ dysfunction syndrome (MODS).

Signs of Heat stroke to Be Aware Of :

Body temperature rises to 40°C or higher.
Dizziness and headache.
Skin turns red but does not sweat.
Nausea and vomiting.
Muscle weakness and cramps.
Rapid heartbeat.
Behavioural changes, such as confusion, restlessness, irritability, or drowsiness.
Seizures and fainting.

The Diagnosis of Heat Stroke Is Clinical :

Diagnostic criteria :

Core body temperature ≥40°C.
Altered mental status.
History of heat exposure or strenuous activity.
Absence of other causes such as central nervous system infection.

Supporting Examinations.

Laboratory: electrolytes, CK, kidney function, liver function, blood gases.
ECG: electrolyte disturbances.
Urinalysis: myoglobinuria.
Imaging if other causes are suspected.

See Also: Chest Pain

Heat Stroke Management ( Complete and Detailed ) :

Management must be initiated IMMEDIATELY, while simultaneously lowering body temperature.

Initial Stability (Primary Survey).
Airway, Breathing, Circulation (ABC).

Position the patient supine.
Administer oxygen at 10–15 L/minute.
If unconscious → intubate.

Monitor.

Core temperature with a rectal/esophageal thermometer.
ECG.
O₂ saturation.
Blood pressure every 3–5 minutes.

Intravenous access.

Administer cold crystalloid fluids (20–30 mL/kg).
Target perfusion : MAP ≥65 mmHg.

Lowering Body Temperature (Cooling Therapy).

Target : temperature of 38.5–39°C within the first 30 minutes. Primary method (gold standard)

Immersion Cooling (Cold Water Immersion).

Immerse the patient in cold water at 1–10°C.
Fastest cooling: 0.15–0.20°C per minute.
Proven to reduce mortality in EHS.

Evaporative Cooling :

Spray or wet the skin with cold water.
Use a large fan.
Place ice packs on the following areas : Neck, Armpits, Groin, Stomach.

Ice Packs / Ice Towel : Apply ice cloth all over the body.
Cold IV Fluids : Give normal saline cold but not as the sole main therapy.
Management of fluids and electrolytes in heat stroke :

Correct hypovolaemia with crystalloids.
Monitor sodium, potassium, and renal function.
Avoid overhydration due to the risk of pulmonary oedema.

Complication Therapy :
Rhabdomyolysis.

Administer aggressive fluids.
Target urine output >200 mL/hour.
Consider urine alkalinization.

Seizures.

Diazepam 5–10 mg IV.
or Midazolam 2–5 mg IV.

Shock.

Norepinephrine is the vasopressor of choice.

DIC.

Administer FFP, platelets as indicated.

ARDS.

Mechanical ventilation according to lung-protective protocol.

Complications that can occur in a person with Heat Stroke are :

Rhabdomyolysis.
Acute Kidney Injury.
Hepatic injury.
DIC.
Cerebral edema.
Acute respiratory distress syndrome (ARDS).
Permanent neurological damage.
Multiple Organ Dysfunction Syndrome (MODS).
Death.

First Aid For Heatstroke :

Heatstroke is a potentially fatal medical emergency. Seek medical attention immediately if you or others feel faint, dizzy or nauseous, stop sweating, or lose consciousness. It’s crucial to take heatstroke seriously and act quickly, as delays can lead to severe complications or even death.

Call For Emergency Medical Help.

Dial emergency services immediately to get professional medical assistance on the way before doing anything else.

Aggressive Cooling.

Use any available means to cool the person down while waiting for medical help. Loosen or remove any unnecessary clothing to help the person cool down.

Move the person to a shady or air-conditioned location immediately and apply cold, wet cloths or towels to their body. Use ice packs and fans if available or immerse in a cold-water bath if possible and safe.

Monitor Until Help Arrives.

Keep a close eye on the person’s condition while waiting for medical assistance. Look for signs of improvement or deterioration.

Tips For Preventing Heatstroke :

Wear loose-fitting, light-coloured, lightweight clothing when outdoors.
Wear a wide-brimmed hat to protect your head and face from direct exposure to the sun.
Apply sunscreen with an SPF of at least 30 evenly to all exposed skin.
Stay hydrated by drinking plenty of water regularly.
Avoid strenuous physical activity outdoors when the temperature is very high.
Take regular breaks in the shade when working outdoors.

In conclusion, a rapid and controlled decrease in temperature is a key factor in preventing permanent organ damage and improving the prognosis of heat stroke patients, while prevention efforts through hydration, acclimatization, and environmental education remain an important strategy in reducing morbidity and mortality.

Heat stroke can cause permanent disability or death if the person does not receive emergency treatment.(*)