Heat Stroke

Heat Stroke is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • Heat stroke occurs in two varieties: classic and exertional. Both are present with high core temperatures that result in direct thermal tissue injury. Secondary effects include acute renal failure from rhabdomyolysis. Even with rapid therapy, mortality rates can be very high for body temperatures above 41.1°C (106°F). The distinction between classic and exertional heat stroke is not important because the therapeutic goals are similar in both and a delay in cooling increases mortality rate.
  • The cardinal features of heat stroke are hyperthermia (>40°C [104°F]) and altered mental status. Although patients presenting with classic heat stroke may have anhidrosis, this is not considered a diagnostic criterion because 50% of patients are still diaphoretic at presentation.
  • The CNS is very vulnerable to heat stroke with the cerebellum being highly sensitive. Ataxia may be an early sign. Seizures are common. Neurologic injury is a function of maximum temperature and duration of exposure.1

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