Heat stroke is hyperthermia (>41.6 Celsius / 106 Fahrenheit) plus neurologic findings (e.g., altered mental status, seizures, coma, etc.); it also causes systemic inflammation response syndrome (i.e., cytokine release), coagulation disorders (e.g., thrombosis in end organs) and tissue abnormalities (e.g., acute kidney injury and rhabdomyolysis)
Two classifications exist:
Exertional heatstroke (young people engaged in strenuous physical activities in hot climates)
Non-exertional heatstroke occurring in sedentary people (elderly, debilitated, or chronically-ill patients) who are unprotected from the elements (e.g., trapped in apartments during heat waves)
Treatment includes:
Insertion of a continuous core thermometer
Supporting ABC’s
Cooling by at least to 0.2 degrees celsius per minute to 39 degrees (to avoid overshoot)
Benzodiazepines for sedation, shivering, and seizures
Antipyretics and phenytoin have not been shown beneficial
Support and protect end-organs with particular attention to kidneys; increased risk of kidney injury from rhabdomyolysis, ischemia and systemic inflammation.
Despite the most aggressive therapy, up to 30% survivors may have permanent neurologic or multi-organ system dysfunction months to years after recovery
References
Leon, L. Heat stroke: role of the systemic inflammatory response. Journal of Applied Physiology 2010 Dec;109(6):1980-8
