Treatment of Heatstroke
The treatment of heatstroke is a medical emergency requiring immediate and aggressive intervention to lower the core body temperature and prevent permanent organ damage or death. As soon as heatstroke is suspected—defined by a core temperature of 40°C or higher and signs of central nervous system dysfunction—emergency measures must begin without delay. The key goals in the treatment of heatstroke are rapid cooling, stabilisation of vital functions, and the management of complications affecting the brain, kidneys, heart, liver, and coagulation systems.
Time is of the essence. Every minute that passes without reducing body temperature increases the risk of irreversible damage. Studies have shown that initiating cooling within the first 30 minutes of symptom onset can dramatically reduce the likelihood of mortality and long-term disability. Therefore, diagnosis and treatment often occur simultaneously, especially in field settings or during transport to hospital.
The most effective and immediate strategy is rapid cooling, ideally through cold water immersion. This involves submerging the individual in a bath of cold or ice water (1.7°C–15°C), which can reduce core body temperature by up to 0.2°C per minute. This method is particularly effective in exertional heatstroke, such as among athletes or military personnel. While it can be logistically difficult in all settings, cold water immersion remains the gold standard.
If immersion is not possible, then people use evaporative cooling methods instead. For example, they spray cool water on the body and fan the person to help the water evaporate and take heat away. Also, placing ice packs on important areas like the neck, groin, armpits, and behind the knees helps pull heat from the body’s vital parts. Additionally, fans, air conditioning, and cold, wet towels all support cooling when immersion isn’t an option.
Treatment of Heatstroke
Removing clothing is very important to help the body lose heat. Therefore, take off any tight, heavy, or warm clothes so the skin can cool down as much as possible. Also, if the person is awake and able, encourage them to lie down flat in a cool, shaded, and breezy place while you keep cooling them actively.
For non-exertional (classic) heatstroke, which often affects elderly or chronically ill individuals during heatwaves, cooling may need to be more gradual to avoid triggering cardiovascular complications. Nonetheless, core temperature must still be brought below 38.9°C (102°F) as quickly as possible, using methods appropriate to the patient’s age and condition.
Airway, breathing, and circulation (ABCs) need to be checked all the time. If the person is unconscious or having seizures, their airway might get blocked. Therefore, emergency responders should give oxygen and be ready to insert a breathing tube if needed. Seizures might need medicine called benzodiazepines, and it is important to quickly fix any imbalances in the body’s minerals to stop heart problems.
Intravenous Fluid Resuscitation
Intravenous (IV) fluids play a key role in treatment. Most people with heatstroke lose a lot of water, so giving IV fluids helps bring back their blood volume, keep their blood pressure steady, and control their body temperature. Usually, doctors start with isotonic saline for this. However, it’s important to watch fluid levels closely, especially if the person shows signs of kidney problems or fluid buildup in the lungs.
Electrolyte imbalances are common and must be corrected based on laboratory results. Hyperkalaemia (high potassium) can lead to life-threatening arrhythmias, while hyponatraemia (low sodium) can exacerbate cerebral oedema and neurological symptoms. Blood glucose should also be checked and managed as needed, especially in diabetic patients or children.
Monitoring for complications is very important throughout treatment. For example, muscle breakdown, called rhabdomyolysis, often happens in heatstroke caused by exercise and can damage the kidneys quickly. Therefore, caregivers should watch urine output closely. Dark, cola-coloured urine is a warning sign of muscle toxins in the urine. In serious cases, doctors may need to use dialysis to help the kidneys work.
Treatment of Heatstroke
Liver function should be checked often. In heatstroke, liver enzymes usually go up, and in the worst cases, sudden liver failure can happen. Also, doctors need to watch blood clotting because heatstroke can cause a serious clotting problem called disseminated intravascular coagulation (DIC). Early signs include bleeding that lasts longer than usual, bruises, and unusual results on clotting tests.
Neurological checks should happen constantly during treatment. Caregivers need to watch and note the patient’s alertness, how they respond to touch or sound, and any seizures. Although cooling helps, it might not fix brain damage if treatment starts late. However, acting quickly often helps healthy people fully recover.
In children, the same rules apply, but caregivers must cool them carefully to prevent shivering or shock. For example, sponge baths, cool misting, and cold packs often work better than full immersion, especially for smaller kids. Also, because children lose water quickly, they should get IV fluids right away if they cannot drink.
Antipyretic Medications
Antipyretic medications, such as paracetamol or ibuprofen, are ineffective and should not be used in heatstroke. These drugs work by altering the body’s hypothalamic temperature set point in fever—not by treating hyperthermia from external heat overload. Their use may delay proper treatment and give a false sense of improvement.
Once stabilised, patients are typically admitted to an intensive care unit (ICU) for further observation and management. Long-term effects such as cognitive impairment, kidney damage, or liver dysfunction may not be immediately apparent and require ongoing assessment. Follow-up care includes imaging, neurological evaluation, and in some cases, physiotherapy or rehabilitation for functional deficits.
Patient education and community outreach are also integral to the treatment of heatstroke—especially in individuals at high risk of recurrence. People who have experienced heatstroke once are more likely to develop it again, often with more severe consequences. Ongoing advice regarding hydration, heat avoidance, and early symptom recognition can prevent future episodes.
Treatment of Heatstroke
In summary, the treatment of heatstroke hinges on early recognition, rapid cooling, supportive care, and complication management. It is a time-critical emergency with potentially devastating consequences, but with swift and effective intervention, survival and full recovery are possible. Multidisciplinary care—combining emergency services, intensive care, and post-acute rehabilitation—is often required to ensure the best outcomes.
