Heat Stroke

We discussed a case of an elderly woman who presented with fever (up to 39.4C), hypotension, acute encephalopathy, due to heat stroke.


  • Core temp > 40C (104F) + CNS dysfunction + exposure to severe environmental heat


  • Exertional vs Nonexertional


  • Pulm (aspiration, bronchospasm, noncardiogenic pulm edema, ARDS)
  • Cardiac (hypotension, arrhythmias)
  • MSK (rhabdomyolysis)
  • GI (hepatic injury)
  • Renal (AKI / renal failure)
  • Neuro (seizures, cerebral edema)
  • Heme (DIC)


  • ABCs!
  • Rapid cooling via evaporative and convective methods (spray water + fan)
  • Fluid resuscitation
  • Pharmacologic therapies (eg acetaminophen, dantrolene) are NOT effective

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