Heat stroke

Last reviewed: 3 Jun 2022
Last updated: 16 Jun 2020

Summary

Definition

History and exam

Key diagnostic factors

  • profound central nervous system disturbance
  • hyperthermia
More key diagnostic factors

Other diagnostic factors

  • headache
  • nausea and vomiting
  • anxiety
  • dizziness
  • tachycardia
  • jaundice
  • muscle tenderness
  • hypotension
  • gastrointestinal bleeding
  • bruising and skin bleeding
Other diagnostic factors

Risk factors

  • older age
  • impaired cognition
  • patients unable to care for themselves
  • medications
  • people who are unacclimatized to hot environments
  • young, active people exercising intensely under hot, humid conditions
More risk factors

Diagnostic investigations

1st investigations to order

  • core temperature measurement
  • serum electrolytes
  • CBC
  • LFTs
  • metabolic profile
  • renal function tests
  • creatine kinase
  • prothrombin time, activated PPT, and INR
  • lactic acid
  • urinalysis
  • chest x-ray
  • arterial blood gas
  • medication/toxicology screen
  • thyroid function tests
  • plasma glucose
More 1st investigations to order

Investigations to consider

  • cranial CT scan
  • lumbar puncture
  • blood culture
More investigations to consider

Treatment algorithm

ACUTE

heat exhaustion

heat stroke

Contributors

Authors

James L. Glazer, MD, FACSM, CAQSM

Assistant Professor

Tufts University School of Medicine

Boston

MA

Disclosures

JLG declares that he has no competing interests.

Peer reviewers

Martin Bocks, MD

Clinical Lecturer

University of Michigan Congenital Heart Center

Ann Arbor

MI

Disclosures

MB declares that he has no competing interests.

James Milledge, MBBS

Honorary Professor

Department of Physiology

UCL

London

Disclosures

JM declares that he has no competing interests.

Paul Hamilton, MD

Director

Department of Emergency Medicine

Mount Sinai School of Medicine

New York

NY

Disclosures

PH declares that he has no competing interests.

  • Differentials

    • Delirium
    • Meningitis
    • Diabetic ketoacidosis
    More Differentials
  • Guidelines

    • National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses
    • Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Heat-Related Illness: 2014 Update
    More Guidelines
  • Patient leaflets

    Heat stroke

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer