🚑 EmergencyEnvironmental / EmergencyStudentInternResident

Heat Stroke

Also known as: heatstroke · hyperthermia · heat illness

A life-threatening rise in core temperature (typically above 40°C) with central-nervous-system dysfunction (confusion, seizures, coma) and multi-organ risk. Rapid cooling saves lives — cool first, transport second.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Exertional (young labourers or athletes in the heat) and classic/non-exertional (elderly, infants, chronic illness, some drugs) during heatwaves.

Red flags — escalate / refer

Altered mental state, seizures, hypotension, or organ dysfunction (rhabdomyolysis, AKI, DIC, liver injury) → emergency aggressive cooling and support.

Work-up / diagnosis

1Measure the core (rectal) temperature and assess mental state.
2Check glucose, electrolytes, renal and liver function, creatine kinase and clotting (rhabdomyolysis/DIC); look for a precipitant and exclude infection.

Management — overview

Rapid cooling is the priority — move to shade/cool, remove clothing, and use evaporative cooling or cold/ice-water immersion (best for exertional heat stroke) to target, then stop to avoid overshoot.
Support airway, breathing and circulation with IV fluids.
Control shivering and seizures; manage complications (rhabdomyolysis, AKI, DIC).
Antipyretics do NOT work in heat stroke.

In-depthFull dosing & advanced protocol

Drug dosing

IV fluids + active cooling

Restore circulation; lower core temperature

Adult dose: Per protocol; cool to target then stop to avoid overshoot
Route: Intravenous / physical cooling

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Benzodiazepine

Shivering / seizures

Adult dose: Per protocol
Route: IV

Caution: Antipyretics (paracetamol/NSAID) are ineffective and may harm the liver/kidney.

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Cool first, transport second

Cold-water immersion is the fastest cooling method for exertional heat stroke.
Antipyretics do not lower temperature in heat stroke (the set-point is normal).
Watch for rhabdomyolysis, acute kidney injury and DIC.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV fluids + active cooling

Benzodiazepine

📈 Cool first, transport second

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV fluids + active cooling

Benzodiazepine

📈 Cool first, transport second

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Cool first, transport second

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Cool first, transport second

References