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 | | Diagnosis | |
- Consider exertional heatstroke in patients engaging in strenuous physical activity, usually under heat stress conditions.
- Consider classic heatstroke in unacclimated sedentary individuals exposed to hot ambient temperature or weather conditions.
- Obtain appropriate laboratory studies to document multi-organ dysfunction in exertional heatstroke.
- Obtain appropriate laboratory studies to document multi-organ dysfunction in classic heatstroke.
- Consider other causes of collapse and abnormal mental status in patients with suspected heatstroke.
| | History and Physical Examination Elements for Heatstroke (table)
| | Laboratory and Other Studies for Heatstroke (table)
| | Differential Diagnosis of Heatstroke (table)
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Consider exertional heatstroke in patients engaging in strenuous physical activity, usually under heat stress conditions.  |
- Consider exertional heatstroke in patients who are:
- Young
- Usually healthy
- Highly motivated
- Not acclimated to heat
- Overweight
- Dehydrated
- Taking medications that put them at risk for heat exhaustion
- On history, ask about:
- Acute GI illness before activity
- Collapse during strenuous physical activity, usually, but not necessarily, under moderate to heavy environmental heat stress
- High rectal temperature measurement immediately after event (>40°C [104°F]), especially when accompanied by hypotension, profuse sweating, and neurologic irritability
- Absence of other etiologies for collapse, e.g., cardiovascular, neurologic
- High occupational risk for exertional heatstroke such as in soldiers, underground miners, firefighters, manual laborers, and athletes
- Note that cases of exertional heatstroke are sporadic.
- See table History and Physical Examination Elements for Heatstroke.
| Background | Back to top
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Consider classic heatstroke in unacclimated sedentary individuals exposed to hot ambient temperature or weather conditions. |
- Consider classic heatstroke disease in patients who are:
- Elderly, especially those who are confined to a bed, unable to care for themselves, and do not leave home daily
- Usually unhealthy
- Of low socioeconomic class
- On multiple medications
- Inhabitants of cold climate countries who are unacclimated to heat conditions
- On history, ask about:
- Associated diseases such as hypertension, diabetes, and alcoholism
- Collapse during heat wave periods
- High rectal temperature measurement immediately after event (>40°C [104°F]), although increased temperature is not necessary for diagnosis
- Absence of other etiologies for altered consciousness
- Drugs that affect thermoregulation, e.g., atropine
- Note that classic heatstroke occurs in epidemic outbreaks.
- See table History and Physical Examination Elements for Heatstroke.
| Background | Back to top
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Obtain appropriate laboratory studies to document multi-organ dysfunction in exertional heatstroke. |
- Look for the following laboratory abnormalities in patients with suspected exertional heatstroke, recognizing that the higher the levels, the more severe the heatstroke:
- Elevated levels of serum CPK: 10,000-200,000 IU/L (common)
- Elevated levels of serum ALT and AST: >1000 IU/L in severe cases (common)
- Elevated levels of serum direct bilirubin: >1 mg/dL
- Markedly elevated levels of BUN and creatinine
- Acid-base disturbances: lactic acidosis
- Coagulation disturbances: prolonged PT/PTT
- Leukocytosis
- See table Laboratory and Other Studies for Heatstroke.
| Background | Back to top
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Obtain appropriate laboratory studies to document multi-organ dysfunction in classic heatstroke. |
- Look for the following laboratory abnormalities in patients with suspected classic heatstroke, recognizing that higher levels may be correlated with severity of disease:
- Elevated levels of serum direct bilirubin: >1 mg/dL
- Mildly elevated levels of BUN and creatinine
- Acid-base disturbances: respiratory alkalosis
- Arterial blood gases: partial pressure of CO2 and O2 in the blood
- Pathologic CXR result suggesting infection or ARDS
- Bacterial growth in blood cultures
- Coagulation disturbances: prolonged PT/PTT, FDP, thrombocytopenia, D-dimer
- Leukocytosis
- See table Laboratory and Other Studies for Heatstroke.
| Background | Back to top
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Consider other causes of collapse and abnormal mental status in patients with suspected heatstroke. |
- In patients with collapse and suspected heatstroke, consider:
- Myocardial infarction
- Arrhythmias
- Neurologic dysfunction
- Metabolic disorders
- Sepsis
- Drug or substance intoxication
- See table Differential Diagnosis of Heatstroke.
| Background | Back to top
| | | FAQs |
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| Dani Moran, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. James Glazer, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Liran Mendel, BMedSc has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Moshe Rav-Acha, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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Heatstroke
