Am Fam Physician. 2025;112(6):700-702
Author disclosure: Michelle Nelson, MD, disclosed stock ownership in Eli Lilly. This relevant financial relationship was mitigated when she sold her shares in May 2024, before her work on this content began.
| • A drink-to-thirst approach is recommended to maintain adequate hydration during activity. |
| • Patients should be treated empirically for heat stroke when there is clinical suspicion, even with an unknown core temperature. |
| • Whole-body ice water immersion is the preferred treatment for heat stroke. |
| From the AFP Editors |
Heat illness leads to 700 deaths each year in the United States. Heat stroke, the most severe form of heat illness, has a 5% mortality rate, and 16% of survivors have a poor neurologic outcome. In patients presenting with heat illness complicated by hypotension, the mortality rate increases to 33%. The Wilderness Medical Society published updated guidelines for prevention and treatment of heat illness.
TERMINOLOGY
Heat stroke is defined as a core temperature greater than 104°F (40°C) with central nervous system dysfunction demonstrated by encephalopathy, seizures, or coma. Exertional heat stroke results from pathologic hyperthermia during strenuous exercise, and nonexertional heat stroke results from passive exposure to high environmental temperatures.
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