Heat Stroke

Overview

Heat stroke is the most severe form of heat-related illness and constitutes a true medical emergency. It occurs when the body's temperature regulation system becomes overwhelmed and fails, causing core body temperature to rise to dangerous levels, typically above 104°F (40°C). Unlike heat exhaustion, heat stroke involves severe central nervous system dysfunction and can rapidly lead to death if not treated immediately.

The condition represents a complete breakdown of the body's thermoregulatory mechanisms. When these systems fail, body temperature rises uncontrollably, leading to cellular damage throughout the body, particularly affecting the brain, heart, kidneys, and muscles. The mortality rate for heat stroke ranges from 10% to 50%, even with aggressive treatment, making rapid recognition and emergency intervention crucial for survival.

Heat stroke can affect anyone but is particularly dangerous for vulnerable populations including infants, elderly individuals, outdoor workers, and athletes. The condition can develop within minutes during extreme heat exposure or physical exertion, and permanent neurological damage can occur if treatment is delayed. Understanding the signs and symptoms of heat stroke, along with proper prevention strategies, is essential for protecting yourself and others during hot weather conditions or strenuous physical activities.

Types of Heat Stroke

Heat stroke is classified into two main types based on the circumstances and population affected. Both types are equally dangerous and require immediate emergency treatment.

Classic (Non-exertional) Heat Stroke

Classic heat stroke typically affects vulnerable populations during periods of extreme environmental heat, such as heat waves. It develops gradually over days and is characterized by:

• Population affected: Elderly, infants, chronically ill individuals
• Setting: High ambient temperature, usually indoors without air conditioning
• Onset: Gradual development over hours to days
• Skin presentation: Hot and dry (anhidrosis - absence of sweating)
• Risk factors: Age extremes, chronic diseases, medications, social isolation
• Complications: Multi-organ failure, particularly cardiovascular and renal

Exertional Heat Stroke

Exertional heat stroke occurs in otherwise healthy individuals engaged in strenuous physical activity in hot conditions. It can develop rapidly and is characterized by:

• Population affected: Athletes, military personnel, outdoor workers, young adults
• Setting: Physical exertion in hot, humid conditions
• Onset: Rapid development, often within hours
• Skin presentation: May still be sweating initially
• Risk factors: Poor fitness, inadequate acclimatization, dehydration
• Complications: Rhabdomyolysis, acute kidney injury, liver damage

Key Differences

Symptoms

Heat stroke symptoms develop rapidly and represent a medical emergency requiring immediate intervention. The hallmark signs include high body temperature, altered mental status, and central nervous system dysfunction. Early recognition is critical as symptoms can progress to coma and death within hours.

Cardinal Signs

Neurological Symptoms

• Confusion - Disorientation to time, place, or person
• Agitation - Restlessness, combativeness, or irritability
• Severe dizziness - Loss of balance and coordination
• Intense headache - Severe, throbbing pain
• Slurred speech (dysarthria)
• Ataxia (loss of coordination)
• Seizures
• Coma
• Delirium or hallucinations

Physical Signs

• Skin changes:
  • Hot, dry skin (classic heat stroke)
  • Hot, sweaty skin initially (exertional heat stroke)
  • Flushed or red appearance
  • Skin that feels burning to touch
• Cardiovascular signs:
  • Rapid, strong pulse initially
  • Later: weak, rapid pulse
  • Hypotension (low blood pressure)
  • Cardiac arrhythmias
• Respiratory symptoms:
  • Shortness of breath
  • Rapid, shallow breathing
  • Hyperventilation

Gastrointestinal Symptoms

• Nausea and vomiting - Often severe and persistent
• Diarrhea - May be bloody
• Abdominal cramping
• Loss of appetite

Other Critical Signs

• Anhidrosis: Complete absence of sweating despite heat
• Oliguria/Anuria: Decreased or absent urine production
• Muscle rigidity: Stiffness or spasticity
• Hyperthermia: Rectal temperature >104°F (40°C)

Warning Signs of Imminent Collapse

Heat Stroke vs Heat Exhaustion

Critical differences that distinguish heat stroke from heat exhaustion:

• Temperature: Heat stroke >104°F vs Heat exhaustion 101-104°F
• Mental status: Heat stroke has altered consciousness vs Heat exhaustion maintains normal mental function
• Sweating: Heat stroke often absent vs Heat exhaustion profuse sweating
• Severity: Heat stroke is life-threatening emergency vs Heat exhaustion is urgent but treatable

Causes

Heat stroke occurs when the body's thermoregulatory system fails completely, unable to dissipate heat effectively. This failure can result from overwhelming environmental conditions, excessive heat production, impaired cooling mechanisms, or a combination of factors that exceed the body's adaptive capacity.

Environmental Factors

• Extreme ambient temperature:
  • Air temperature >95°F (35°C)
  • Heat index values >105°F (40.5°C)
  • Sudden heat waves
  • Prolonged exposure to high temperatures
• High humidity:
  • Relative humidity >60%
  • Impaired evaporative cooling
  • Reduced sweat evaporation
• Poor environmental conditions:
  • Lack of air conditioning
  • Poor ventilation
  • Direct sun exposure
  • Reflective surfaces increasing heat load
  • Urban heat island effects

Excessive Heat Production

• Strenuous physical activity:
  • Intense exercise in hot conditions
  • Athletic competitions
  • Military training
  • Occupational physical labor
• Metabolic factors:
  • Fever from infections
  • Hyperthyroidism
  • Drug-induced hyperthermia
  • Malignant hyperthermia

Impaired Heat Dissipation

• Cardiovascular insufficiency:
  • Heart failure
  • Dehydration reducing blood volume
  • Peripheral vascular disease
  • Medications affecting circulation
• Compromised sweating:
  • Dehydration
  • Electrolyte imbalances
  • Skin conditions (extensive burns, psoriasis)
  • Medications that impair sweating
  • Congenital anhidrosis

Thermoregulatory Dysfunction

• Age-related changes:
  • Immature thermoregulation in infants
  • Declining hypothalamic function in elderly
  • Reduced perception of heat
  • Decreased cardiovascular reserve
• Neurological conditions:
  • Parkinson's disease
  • Spinal cord injuries
  • Hypothalamic disorders
  • Previous heat stroke damage

Drug-Related Causes

• Medications impairing thermoregulation:
  • Anticholinergics (reduce sweating)
  • Diuretics (promote dehydration)
  • Beta-blockers (reduce cardiac output)
  • Antihistamines (impair sweating)
  • Antipsychotics (affect hypothalamus)
• Substance abuse:
  • Alcohol (impairs judgment and thermoregulation)
  • Stimulants (increase heat production)
  • MDMA/Ecstasy (severe hyperthermia risk)

Pathophysiological Cascade

1. Heat exposure exceeds dissipation capacity
2. Core temperature rises above 40°C (104°F)
3. Cellular proteins denature and malfunction
4. Inflammatory cascade activation
5. Multi-organ system failure:
   • Central nervous system dysfunction
   • Cardiovascular collapse
   • Acute kidney injury
   • Liver failure
   • Coagulopathy
6. Death from multi-organ failure

Risk Factors

Certain individuals face significantly higher risks of developing heat stroke due to physiological, medical, environmental, or behavioral factors. Understanding these risk factors is crucial for prevention and early intervention strategies.

Age-Related Risk Factors

• Infants and young children (under 4 years):
  • Immature thermoregulatory system
  • Higher surface area to body mass ratio
  • Cannot remove themselves from heat
  • Dependence on caregivers for cooling
  • Risk of being left in hot vehicles
• Elderly individuals (over 65 years):
  • Declining physiological reserve
  • Reduced sensitivity to temperature changes
  • Decreased thirst sensation
  • Impaired cardiovascular response
  • Reduced sweating capacity
  • Social isolation during heat waves

Medical Conditions

• Cardiovascular diseases: Heart failure, coronary artery disease, hypertension
• Neurological disorders: Parkinson's disease, multiple sclerosis, spinal cord injury
• Endocrine conditions: Diabetes, hyperthyroidism, adrenal insufficiency
• Respiratory diseases: COPD, asthma (severe forms)
• Kidney disease: Chronic renal failure, dialysis patients
• Mental health conditions: Dementia, psychosis, severe mental illness
• Skin conditions: Extensive burns, severe psoriasis, scleroderma
• Previous heat stroke: Permanent damage to thermoregulatory system

Medications

• Diuretics: Furosemide, thiazides (increase fluid loss)
• Anticholinergics: Atropine, scopolamine (reduce sweating)
• Antihistamines: Diphenhydramine, promethazine (impair sweating)
• Antipsychotics: Haloperidol, chlorpromazine (affect hypothalamus)
• Antidepressants: Tricyclics, MAOIs (affect thermoregulation)
• Beta-blockers: Reduce cardiovascular response to heat
• Calcium channel blockers: Affect vascular response
• Stimulants: Amphetamines, cocaine (increase heat production)

Occupational and Activity Risks

• High-risk occupations:
  • Construction and road workers
  • Agricultural workers
  • Firefighters and emergency responders
  • Military personnel
  • Athletes and coaches
  • Kitchen and factory workers
  • Roofers and landscapers
• Athletic activities:
  • Football with heavy protective equipment
  • Marathon running and endurance sports
  • Tennis and outdoor sports in summer
  • Military training exercises

Environmental and Social Risk Factors

• Housing conditions:
  • No air conditioning
  • Poor ventilation
  • Upper floor apartments
  • Metal or dark-colored roofing
  • Urban heat island exposure
• Social factors:
  • Poverty and inability to afford cooling
  • Homelessness
  • Social isolation
  • Language barriers
  • Limited access to transportation

Physical and Behavioral Factors

• Physical fitness:
  • Poor cardiovascular conditioning
  • Obesity (impairs heat dissipation)
  • Dehydration
  • Sleep deprivation
  • Recent illness with fever
• Behavioral risks:
  • Inadequate fluid intake
  • Alcohol consumption
  • Inappropriate clothing
  • Ignoring heat warnings
  • Continuing activity despite symptoms

Acclimatization Status

• Non-acclimatized individuals:
  • Recent arrivals from cooler climates
  • First few days of heat wave
  • Beginning of sports season
  • Return to activity after break
• Incomplete acclimatization:
  • Less than 10-14 days of heat exposure
  • Interrupted acclimatization process
  • Seasonal workers early in season

Diagnosis

Heat stroke diagnosis is primarily clinical and must be made rapidly to initiate life-saving treatment. The diagnosis is based on clinical presentation, core body temperature measurement, and evidence of central nervous system dysfunction in the setting of heat exposure. Laboratory studies support the diagnosis and help assess complications.

Clinical Diagnostic Criteria

Heat stroke diagnosis requires the presence of:

1. Hyperthermia: Core body temperature ≥104°F (40°C)
2. Central nervous system dysfunction: Altered mental status, confusion, delirium, seizures, or coma
3. History of heat exposure: Environmental heat or strenuous activity

Core Temperature Measurement

• Preferred methods:
  • Rectal temperature (most accurate)
  • Esophageal temperature probe
  • Bladder temperature (catheter with sensor)
• Less reliable methods:
  • Oral temperature (affected by hyperventilation)
  • Axillary temperature (significantly underestimates)
  • Temporal artery scanners (may underestimate)
• Important considerations:
  • Temperature may be normal if cooling has been initiated
  • Some patients may present with lower temperatures
  • Continuous monitoring is essential

Clinical Assessment

History

• Environmental conditions and duration of exposure
• Activity level and intensity prior to symptoms
• Fluid intake and last urination
• Onset and progression of symptoms
• Previous heat-related illness
• Current medications
• Substance use (alcohol, drugs)
• Medical history and chronic conditions

Physical Examination

• Vital signs:
  • Core temperature ≥104°F (40°C)
  • Tachycardia (may progress to bradycardia)
  • Hypotension
  • Tachypnea
• Neurological examination:
  • Mental status assessment
  • Glasgow Coma Scale
  • Focal neurological deficits
  • Reflexes and muscle tone
• Skin examination:
  • Hot, dry skin (classic) or hot, sweaty (exertional)
  • Color (flushed, pale, cyanotic)
  • Capillary refill time
  • Signs of dehydration

Laboratory Studies

Initial Laboratory Tests

• Complete blood count:
  • Hemoconcentration from dehydration
  • Leukocytosis (white blood cell elevation)
  • Thrombocytopenia (low platelets)
• Comprehensive metabolic panel:
  • Electrolyte abnormalities (sodium, potassium)
  • Hyperglycemia or hypoglycemia
  • Elevated BUN and creatinine (kidney injury)
  • Metabolic acidosis
• Liver function tests:
  • Elevated transaminases (ALT, AST)
  • Elevated bilirubin
  • Decreased synthetic function

Additional Tests

• Coagulation studies: PT/PTT, INR (assess bleeding risk)
• Creatine kinase: Elevated in rhabdomyolysis
• Arterial blood gas: Respiratory alkalosis or metabolic acidosis
• Lactate: Elevated in severe cases
• Troponin: May be elevated due to heat-induced cardiac injury
• Urinalysis: Myoglobinuria, proteinuria, casts

Imaging Studies

• Chest X-ray: Assess for pulmonary edema or aspiration
• CT brain: If focal neurological signs or prolonged altered mental status
• Echocardiogram: If evidence of cardiac dysfunction

Differential Diagnosis

• Other hyperthermic syndromes:
  • Malignant hyperthermia
  • Neuroleptic malignant syndrome
  • Serotonin syndrome
  • Anticholinergic toxicity
• Infectious causes:
  • Sepsis with hyperthermia
  • Central nervous system infections
  • Severe pneumonia
• Other medical emergencies:
  • Thyrotoxic crisis
  • Pheochromocytoma crisis
  • Drug intoxication
  • Withdrawal syndromes

Severity Assessment

• Mild: Temperature 104-105°F, minimal CNS dysfunction
• Moderate: Temperature 105-107°F, moderate CNS dysfunction
• Severe: Temperature >107°F, severe CNS dysfunction, multi-organ failure

Emergency Treatment

Heat stroke treatment is a medical emergency requiring immediate, aggressive intervention. The primary goal is rapid cooling to prevent further cellular damage and death. Treatment must begin immediately, often in the field, and continue during transport and in the hospital setting.

Immediate Field Treatment

Primary Cooling Methods

• Evaporative cooling (most effective):
  • Remove all clothing
  • Spray body with lukewarm water
  • Place large fans to maximize evaporation
  • Continue until core temperature drops to 102°F (39°C)
• Conductive cooling:
  • Apply ice packs to neck, armpits, and groin
  • Ice water immersion (if available and safe)
  • Cold, wet towels over body
  • Avoid ice-cold water (may cause shivering)
• Convective cooling:
  • Move to air-conditioned environment
  • Use fans for air circulation
  • Remove from direct sunlight

Supportive Care

• Airway management:
  • Maintain patent airway
  • Position for drainage if vomiting
  • Consider intubation if comatose
• Circulation support:
  • IV access with large-bore catheters
  • Normal saline or lactated Ringer's solution
  • Monitor for fluid overload
• Monitoring:
  • Continuous core temperature monitoring
  • Cardiac monitoring
  • Blood pressure monitoring
  • Neurological assessments

Hospital Management

Advanced Cooling Techniques

• External cooling:
  • Cooling blankets
  • Arctic Sun or similar devices
  • Continuous evaporative cooling
• Internal cooling (severe cases):
  • Cold saline gastric lavage
  • Cold saline peritoneal lavage
  • Intravascular cooling catheters
  • Extracorporeal cooling (ECMO)

Medical Management

• Fluid resuscitation:
  • Isotonic crystalloids (normal saline, lactated Ringer's)
  • Monitor central venous pressure
  • Avoid excessive fluid administration
  • Consider vasopressors if hypotensive
• Electrolyte management:
  • Correct hypernatremia or hyponatremia
  • Replace potassium and magnesium
  • Monitor calcium levels
• Seizure management:
  • Benzodiazepines (lorazepam, diazepam)
  • Avoid phenytoin (may impair heat dissipation)
  • Consider propofol for refractory seizures

Complications Management

• Acute kidney injury:
  • Monitor urine output and creatinine
  • Maintain adequate perfusion
  • Consider dialysis if severe
• Liver failure:
  • Monitor liver enzymes and function
  • Avoid hepatotoxic medications
  • Consider liver transplant evaluation
• Coagulopathy:
  • Monitor coagulation parameters
  • Replace clotting factors as needed
  • Platelet transfusion if severe thrombocytopenia
• Rhabdomyolysis:
  • Aggressive fluid resuscitation
  • Alkalinization of urine
  • Monitor for hyperkalemia

Monitoring and Goals

• Temperature goals:
  • Rapidly cool to 102°F (39°C)
  • Avoid overcooling (<101°F)
  • Continue monitoring for rebound hyperthermia
• Other monitoring:
  • Neurological status every 15 minutes
  • Vital signs continuously
  • Urine output hourly
  • Laboratory studies every 4-6 hours

Medications to Avoid

• Antipyretics: Aspirin, acetaminophen (ineffective and potentially harmful)
• Anticholinergics: Worsen hyperthermia
• Beta-blockers: May impair heat dissipation
• Phenothiazines: Impair thermoregulation

Recovery and Discharge Criteria

• Neurological function returned to baseline
• Core temperature stable <101°F for 24 hours
• Normal or improving organ function
• Stable vital signs
• Adequate oral intake
• Safe discharge environment with follow-up arranged

Prevention

Prevention of heat stroke is far more effective than treatment and requires a comprehensive approach involving environmental modifications, proper hydration, gradual acclimatization, and recognition of early warning signs. Prevention strategies must be tailored to individual risk factors and environmental conditions.

Environmental Strategies

• Temperature monitoring:
  • Check heat index values daily
  • Use weather apps with heat warnings
  • Plan activities during cooler hours
  • Cancel outdoor activities when heat index >105°F
• Creating cool environments:
  • Use air conditioning when available
  • Visit cooling centers during heat waves
  • Create cross-ventilation with fans
  • Close curtains/blinds during sunny hours
  • Use reflective window films
• Activity modification:
  • Exercise before 10 AM or after 6 PM
  • Take frequent breaks in shade or AC
  • Reduce intensity during hot weather
  • Move activities indoors when possible

Hydration Strategies

• Pre-activity hydration:
  • Drink 16-20 oz of fluid 2-3 hours before activity
  • Additional 8 oz of fluid 15-20 minutes before
  • Check urine color (pale yellow ideal)
  • Weigh yourself to establish baseline
• During activity:
  • Drink 6-8 oz every 15-20 minutes
  • Use sports drinks for activities >60 minutes
  • Don't wait until thirsty
  • Cool fluids (50-60°F) are absorbed fastest
• Post-activity:
  • Replace 150% of fluid lost (weigh yourself)
  • Continue hydrating for several hours
  • Include electrolyte replacement
  • Monitor urine output and color

Clothing and Equipment

• Appropriate clothing:
  • Light-colored, loose-fitting garments
  • Moisture-wicking fabrics
  • Minimal clothing layers
  • Wide-brimmed hat for sun protection
  • UV-protective sunglasses
• Cooling accessories:
  • Cooling towels
  • Portable misting devices
  • Insulated water bottles
  • Personal fans
  • Shade structures (umbrellas, tents)

Acclimatization

• Gradual adaptation process:
  • Allow 10-14 days for full acclimatization
  • Start with 20-30 minutes of heat exposure
  • Increase by 10-20 minutes daily
  • Begin at 50% normal activity intensity
  • Gradually increase to full intensity
• Maintaining acclimatization:
  • Regular heat exposure (at least every 3 days)
  • Maintain fitness during off-season
  • Re-acclimatize after breaks >7 days

High-Risk Population Strategies

• Elderly individuals:
  • Daily check-ins during heat waves
  • Ensure access to air conditioning
  • Review medications with healthcare provider
  • Install temperature monitoring systems
  • Create emergency action plans
• Children:
  • Never leave in vehicles
  • Frequent water breaks during play
  • Limit outdoor activities in extreme heat
  • Watch for behavioral changes
  • Educate about heat safety
• Athletes and workers:
  • Implement heat illness policies
  • Mandatory rest breaks
  • Buddy system monitoring
  • Access to cooling areas
  • Emergency action plans

Community and Workplace Prevention

• Heat action plans:
  • Heat index monitoring systems
  • Activity modifications based on conditions
  • Emergency response protocols
  • Communication systems for warnings
• Education programs:
  • Recognition of heat illness symptoms
  • First aid training
  • Importance of hydration
  • Risk factor awareness
• Policy implementation:
  • Work-rest cycles in hot conditions
  • Mandatory water breaks
  • Cooling area requirements
  • Heat emergency procedures

Warning Signs to Recognize

• Early warning signs:
  • Excessive fatigue or weakness
  • Headache or dizziness
  • Nausea or vomiting
  • Muscle cramps
  • Heavy sweating followed by cessation
• Immediate action required:
  • Stop activity immediately
  • Move to cool environment
  • Begin cooling measures
  • Seek medical attention
  • Do not resume activity same day

Technology and Apps

• Heat index calculators
• Weather apps with heat warnings
• Hydration tracking apps
• Wearable devices monitoring body temperature
• Emergency alert systems

When to See a Doctor

Heat stroke is always a medical emergency requiring immediate professional intervention. However, there are also situations requiring urgent medical evaluation and follow-up care that are crucial for preventing heat stroke or managing its consequences.

Seek Emergency Medical Care For:

• Severe heat-related symptoms:
  • High fever (>103°F) with heat exposure
  • Severe headache with nausea/vomiting
  • Extreme confusion or disorientation
  • Difficulty speaking or slurred speech
  • Loss of coordination or balance
  • Severe muscle cramps that don't improve
• Cardiovascular symptoms:
  • Chest pain with heat exposure
  • Heart palpitations or irregular heartbeat
  • Severe dizziness or fainting
  • Signs of dehydration with inability to drink

Urgent Medical Attention Needed:

• Heat exhaustion symptoms not improving:
  • Symptoms persisting >1 hour with treatment
  • Temperature remaining >101°F (38.3°C)
  • Continued nausea/vomiting preventing hydration
  • Weakness or fatigue preventing normal activities
• High-risk individuals with any heat symptoms:
  • Infants and children under 4
  • Adults over 65
  • Pregnant women
  • People with chronic medical conditions
  • Those taking medications affecting temperature regulation

Same-Day Medical Evaluation For:

• Persistent headache after heat exposure
• Continued nausea or loss of appetite
• Muscle weakness or unusual fatigue
• Dark-colored urine or decreased urination
• Skin that remains hot and flushed
• Any concern about heat-related illness

Follow-up Care Required:

• After heat stroke treatment:
  • Complete neurological evaluation
  • Assessment of organ function recovery
  • Evaluation for permanent thermoregulatory damage
  • Clearance for return to activities
• Recurrent heat-related illness:
  • Multiple episodes of heat exhaustion
  • Heat intolerance after previous heat stroke
  • Decreased ability to tolerate heat
  • Need for activity or work restrictions

Preventive Medical Consultation:

• Before starting high-risk activities:
  • Athletic participation in hot climates
  • Outdoor occupational work
  • Military training or deployment
  • Moving to hotter climate
• Medication review needed:
  • Taking medications that affect heat tolerance
  • Starting new medications in summer
  • Chronic conditions requiring medication adjustments

Special Populations Requiring Lower Threshold:

• Elderly individuals:
  • Any heat-related symptoms
  • Confusion or behavioral changes in heat
  • Dehydration signs
  • During heat wave conditions
• Children:
  • Excessive crying or irritability in heat
  • Decreased activity or play
  • Refusing to drink fluids
  • Any signs of distress
• Chronic medical conditions:
  • Diabetes with heat-related symptoms
  • Heart disease with heat stress
  • Kidney disease with dehydration
  • Mental health conditions affecting judgment

What to Tell Your Doctor:

• Duration and intensity of heat exposure
• Activity level before symptoms
• Fluid intake and urination patterns
• All symptoms and their progression
• Current medications and medical history
• Previous heat-related illness
• Home treatment attempts and response

Emergency Preparation:

• Know locations of nearest emergency departments
• Have emergency contact information readily available
• Understand your insurance coverage for emergency care
• Keep medical history and medication list updated
• Inform family/friends of heat-related risks

Related Conditions

Heat stroke is part of a spectrum of heat-related illnesses and is associated with various medical conditions that either increase the risk of heat stroke or share similar pathophysiology. Understanding these relationships is important for comprehensive care and prevention.

Heat-Related Illness Spectrum

Hyperthermic Syndromes

Predisposing Medical Conditions

Complications and Consequences

Neurological Complications

• Seizures - Can occur during acute heat stroke
• Cerebral Edema - Brain swelling from hyperthermia
• Coma - Severe consciousness impairment
• Ataxia - Coordination problems after heat stroke
• Cognitive Impairment - Potential long-term consequence

Environmental and Occupational Conditions

• Dehydration - Major contributing factor
• Hyponatremia - Can result from excessive water intake
• Sunburn - Impairs skin's cooling ability
• Altitude Sickness - Can compound heat-related stress

Substance-Related Conditions

• Alcohol Intoxication - Impairs thermoregulation and judgment
• Stimulant Overdose - MDMA, amphetamines increase hyperthermia risk
• Anticholinergic Toxicity - Impairs sweating mechanism

Age-Related Vulnerabilities

• Pediatric Hyperthermia - Children's increased vulnerability
• Geriatric Heat Sensitivity - Age-related thermoregulatory decline
• Pregnancy Heat Stress - Increased risk during pregnancy

Frequently Asked Questions