“How hot is hot enough to cause heat illness is a moving target because Predisposing Factors contribute to Death from heat illness and abnormal body heat balance,” says Dr. William O. Roberts.

There are reports of death from heat illness with temperatures in the 70″s. because of Predisposing Risk Factors.

Temperature alone from dehydration from insufficient water consumption might not be the sole cause of heat illness. An athlete patient can be diagnosed with heat illness if one of the following is associated with body heat imbalance and increased lethal body temperature while working or exercising in the heat.

Water consumption errors do not always account for all heat illness death. Predisposing Factors for heat imbalance and increased body heat and death from heat illness will only be definitively ruled in or out after autopsy. However, clinical diagnoses are all that can be relied on in lieu of an autopsy.

There are Primary and Secondary Risk Factors for Heat Stroke.

A. Inadequate Oxygen an/ or Inadequate Airway
B. Breathing Difficulty. Can’t Breathe on their own.
C. Circulation Compromise and Cardiovascular Pathology
D. Poor Air Quality. Increased Ground Level Ozone and other Air Polution. See Publication Heat + Ozone + Synergism + Exercise

In addition the ABC’s of Resuscitation are a mnemonic used in the care of the unconscious or unresponsive patient. It is used as a reminder of the priorities for assessment and treatment of patients in many acute medical and trauma situations. Airway, breathing, and circulation are vital for life, and each is required, in that order, for the next to be effective. The Heat Stroke Patient must have the ABC’s attended and stabilized first in that order.

A. Sympathomimetics (alpha adrenergic agonists)
B. Anticholinergics
Benztropine mesylate
C. Diuretics
Furosemide (Lasix)
Bumetanide (Bumex)
D. Phenothiazines
Chlorpromazine hydrochloride
Promethazine hydrochloride
E. Butyrophenones
Haloperidol (Haldol)
F. Tricyclic Antidepressant
Amitriptyline (Elavil)
G. Monoamine Oxidase Inhibitors
H. Recreational and Illicit Drugs
Lysergic Acid diethylamide (LSD)
Other Medications
Beta Blockers
Calcium Channel Blockers
Heat Illness Prevention
Pathophysiology Predisposing conditions alter heat balance
1. Increased endogenous heat load : Vigorous Exercise or overexertion
2. Increased Exogenous Heat load -Sun Exposure -Increased Heat Index
3. Decreased Heat Dissipation
a. Exogenous cause -Humidity
Occlusive or excessive clothing
b. Endogenous cause –
Lack of acclimatization
Healed burns
Sweat Gland Dysfunction
4. Other predisposing factors for abnormal heat balance
a. Prior Heat Stroke
b. Concurrent infection
Upper Respiratory Infection
c. Elderly
Myocardial dysfunction
Decreased muscle mass
Decreased skin blood supply
Renal insufficiency
Chronic illness
d. Comorbid medical condition
Cystic Fibrosis
Diabetes Insipidus
Poorly controlled Diabetes Mellitus

William O. Roberts, MD, sports medicine MinnHealth in White Bear Lake, Minn Czerkawski (1996) Your Patient Fitness 10(4): 13-20
Sandor (1997) Physician SportsMed, 25(6):35-40
Barrow (1998) Am Fam Physician 58(3):749
Hett (1998) Postgrad Med 103(6):107
Wexler (2002) Am Fam Physician 65(11):2307

Heat Stroke References

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2. Hyperthermia, Wikipedia Encylopedia, October 2006, Retrieved from “”
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7. Randy Eichner “Muscle cramps: the right ways for the dog days”. Coach and Athletic Director. August 2002. 15 Sep. 2007.
8. Maddali Sirish, Rodeo Scott, Barnes Ronnie, Warren Russell, Murrell George: Post-exercise Increase in Nitric Oxide in Football Players with Muscle Cramps. The American Journal of Sports Medicine 26: 820-824, 1998.
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7, June 28, 2007. “Salt pills should not be used without first asking your health care provider.”
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Prepared by Stephen T. Hougen, M.D., F.A.C.S., GETAC Injury Prevention Committee, August 19,
This article describes a parents’ safety meeting following the death of 14 year-old Matthew Thomas.
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Prepared by Stephen T. Hougen, M.D., F.A.C.S., GETAC Injury Prevention Committee, August 19,

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