# Heat Stroke (Emergency Referral) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: WHO Guidance on Public Health Management of Heat Waves 2021 · CDC Climate and Health: Heat and Health 2022 · NICE Clinical Knowledge Summaries: Heat exhaustion and heatstroke 2022 · Egyptian MOH Heat Illness Emergency Management Protocol - Verified date: 2026-08 ## Verified against - WHO Guidance on Public Health Management of Heat Waves 2021 ## Treatment metadata - No drug therapy in primary care (Emergency Referral) ## Complete treatment card ```text HEAT STROKE (EMERGENCY REFERRAL) Sources: WHO Guidance on Public Health Management of Heat Waves 2021 · CDC Climate and Health: Heat and Health 2022 · NICE Clinical Knowledge Summaries: Heat exhaustion and heatstroke 2022 · Egyptian MOH Heat Illness Emergency Management Protocol Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Weakness, tiredness, nausea, vomiting, and dizziness can occur in heat stroke [dizziness · fatigue · nausea · vomiting] - Heat illness is a spectrum that runs from heat exhaustion through heat injury to heat stroke at the life-threatening end [fatigue] - The diagnosis needs both halves: a core temperature usually over 40 °C, and central nervous system dysfunction - ataxia, delirium or seizures - after hot weather or hard exertion [confusion · seizures · unsteadiness] SIGNS - what you find (6) - Heat stroke typically shows a raised core temperature, a fast heart rate, fast breathing, and a widened pulse pressure [tachycardia · tachypnoea] - About one in four patients with heat stroke is hypotensive - Flushing, lung crackles, reduced urine output, and unusual bleeding can be seen [bleeding · crackles] - Classic heat stroke shows hot, dry skin from a failure of the normal sweating response [dry skin · sweating] - Failure to sweat is uncommon in exertional heat stroke; heavy sweating instead continues once exercise stops [sweating] - All patients with heat stroke have a fast heart rate and fast breathing [tachycardia · tachypnoea] TESTS (8) - Workup includes frequent vital signs and rectal temperature, plus CBC, metabolic panel, clotting studies, blood gases, CPK, and urine myoglobin - Toxicology screening, a chest x-ray, and an ECG may be added depending on clinical judgement - ECG can show a prolonged QT interval, ST-segment depression, and other ischaemia-type T-wave abnormalities - Arterial CO2 often falls below 20 mmHg in heat stroke - Classic heat stroke tends to cause respiratory alkalosis, while exertional heat stroke can add lactic acidosis - Exertional heat stroke commonly shows low calcium, high phosphate, and high potassium from muscle breakdown - CPK rises higher in exertional than in classic heat stroke, reflecting more muscle breakdown - A raised AST and ALT is the most common lab finding in classic heat stroke IF NOT THIS - what else fits (4) - Muscle rigidity or clonus is not typical of heat stroke and instead points to neuroleptic malignant syndrome or serotonin syndrome - Malaria, sepsis, and meningitis usually do not reach the same degree of temperature rise as heat stroke - A travel history to a malaria-endemic area should be sought when heat stroke is suspected - A detailed medication review can rule out polypharmacy or a toxic ingestion as the cause Source StatPearls "Heat Stroke" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (EMERGENCY REFERRAL) [1st line] Adult Call emergency services immediately (123 in Egypt) for urgent transport to ICU or emergency department. Initiate immediate aggressive physical cooling on site prior to transport: cold-water immersion or continuous cold water misting with active fanning until core body temperature drops to 38.5°C (101.3°F). Maintain airway, breathing, and circulation. - Immediate emergency transfer and pre-hospital cooling Peds Immediate emergency transport (123). Cool rapidly using wet cloths, fanning, or cold water spray; target core temperature < 38.5°C. Do NOT administer oral fluids if pediatric patient has altered consciousness. Source WHO Guidance on Public Health Management of Heat Waves 2021 Why Heat stroke is a non-pharmacological medical emergency requiring immediate physical body cooling and emergency transfer; antipyretics are ineffective and dangerous. Caution TIME-CRITICAL EMERGENCY (MORTALITY > 10-50% IF DELAYED): Initiate aggressive physical cooling IMMEDIATELY on site — do NOT delay cooling for emergency transport or diagnostic evaluation. DISTINCTION FROM HEAT EXHAUSTION: Heat stroke is defined by core body temperature > 40°C (104°F) WITH central nervous system (CNS) dysfunction (encephalopathy, confusion, delirium, ataxia, seizures, or coma). Heat exhaustion presents with intact mental status and core temp < 40°C. DO NOT ADMINISTER ANTIPYRETICS (paracetamol, aspirin, NSAIDs): Heat stroke hyperthermia is caused by direct environmental heat overload and thermoregulatory failure, NOT prostaglandin-E2 (PGE2) pyrogen-mediated hypothalamic set-point alteration. Antipyretics have zero efficacy and markedly aggravate heat-induced hepatic necrosis, acute kidney injury, and coagulopathy. TARGET COOLING TEMPERATURE: Cool aggressively to a target core body temperature of 38.5°C (101.3°F) to 39.0°C within 30 minutes, then halt active cooling to avoid hypothermic overshoot and shivering. DO NOT administer oral fluids to patients with altered consciousness or coma due to high risk of aspiration pneumonitis. Establish IV access with 0.9% Sodium Chloride if trained personnel are present, but do not delay cooling or transfer. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)