Diagnosis and Management of Heat Stroke and Other Heat-Related Illness in the Emergency Department

Publication Date: June 2026 (Volume 28, Number 6)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 06/01/2029.

Authors

David Fernandez, MD, MHPE

Assistant Professor of Medicine, Emergency Medicine, NewYork-Presbyterian/Weill Cornell Medical Center; Assistant Program Director, NewYork-Presbyterian Cornell-Columbia Emergency Medicine Residency Program, New York, NY

Sophia Gorgens, MD

Clinical Instructor, Department of Emergency Medicine, Yale University, New Haven, CT

Carver Goodhue, MD

Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

Abstract

Heat-related illness encompasses a spectrum of conditions ranging from heat cramps and heat exhaustion to life-threatening heat stroke, all resulting from impaired thermoregulation under excessive environmental heat load. The incidence and severity of heat-related illnesses are increasing, underscoring the need for evidence-based emergency management strategies. Accurate diagnosis requires differentiating heat-related illness from conditions that may mimic hyperthermia. Timely recognition and rapid cooling are the cornerstones of management. This review summarizes current evidence on the diagnosis, treatment, and disposition of heat-related illness in the emergency department, with an emphasis on distinguishing heat stroke from conditions with overlapping clinical presentations and on optimizing cooling interventions.

Case Presentations

CASE 1

A 79-year-old woman with a history of hypertension, diabetes mellitus, and hyperlipidemia presents with altered mental status…

The patient is brought in by her daughter, who reports that she had not heard from her mother in several days and went to check on her. She found the patient in bed in a warm room without air conditioning.
On arrival, the patient appears to be confused but answers questions and moves all extremities spontaneously.
Her vital signs are: temperature, 41°C; heart rate, 121 beats/min; blood pressure, 115/67 mm Hg; respiratory rate, 20 breaths/min; and oxygen saturation, 95% on room air.
You wonder if the patient is presenting with an acute cerebral vascular accident, or if there is an alternative etiology for her symptoms…

CASE 2

A 24-year-old man with no significant past medical history presents with generalized body pain, with the pain greater in his lower extremities than his upper extremities…

As you enter the room, the patient is lying on a stretcher and talking with his partner, although he appears uncomfortable. His vital signs are notable for mild tachycardia.
The patient reports running in the New York City Marathon the previous day and waking up this morning with severe pain. He reports difficulty ambulating to the bathroom due to generalized myalgia and notes that his urine appeared dark.
The nurse has already placed a peripheral IV and sent laboratory studies. The urinalysis is positive for blood with 0 red blood cells on microscopy.
You suspect rhabdomyolysis and await the creatine kinase result…

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