Exertional heatstroke is a top killer of athletes and soldiers-in-training

Heatstroke is sometimes missed because the patient is really sweaty

Since the condition involves losing the ability to cool oneself, clinicians sometimes see someone who has exertional heatstroke—like a high school athlete who is really sweaty—and don't realize the heat-related illness has already progressed to heatstroke. Classic heatstroke typically occurs among the very young or the elderly. (Some users may encounter a paywall.)

Heatstroke occurs when the body reaches 104°F or higher and can't cool itself

Untreated, this medical emergency can result in permanent disability or death. Someone suffering from heatstroke—defined as a core temperature of 104 degrees Fahrenheit but sometimes as high as 106 degrees Fahrenheit—may appear confused and require immediate cooling, ideally with an ice bath.

How heatstroke—from overexertion or extreme heat—affects the body

When core body temperature soars to 104 degrees Fahrenheit or higher and remains there for about 30 minutes, it sets off a cascade of problems in the body. Proteins and cell membranes can degrade and begin to leak, potentially leading to liver damage, blood clots, GI tract damage, and organ failure, among other issues.

Heatstroke is when the body's core temperature becomes dangerously high—and needs to cool

Warning signs that the body is overheating include rapid breathing, cramps, heavy sweating, nausea, and feeling lightheaded. Drinking plenty of fluids, seeking shade, and cooling the body down as quickly as possible with icepacks can help reduce the risk of heatstroke.

67 US high school athletes died from exertional heatstroke between 1982 and 2022

Many of those deaths were from football specifically, where student athletes play in hot conditions while wearing heavy protective gear. Few states mandate heat guidelines for school athletes, and this article says that's of increasing concern with more high heat index days.

Heat exhaustion is the most likely diagnosis if someone is talking clearly

Heatstroke, true to its name, looks more like a stroke. Its symptoms include severe disorientation, irritability, and seizures, among others. A patient does not need to have collapsed in order to have exertional heatstroke, but if someone is talking clearly, they likely have heat exhaustion, and it hasn't progressed to heatstroke.

Heatstroke can reprogram your DNA, putting survivors at risk of future health problems

Severe illness from extreme heat exposure can alter DNA through epigenetics—turning genes "on" or "off" to shape disease risk. These changes can place an organism at greater risk of future health complications—unlike the epigenetic changes produced by moderate, repeated heat exposures.

How the gut microbiome can affect heatstroke risk

Some research suggests that our gut microbiome influences our risk of exertional heatstroke. If exercise boosts our body temperatures to unsafe levels, increasing gut permeability, that can cause a "leaky" gut—allowing bacteria and other gut microbes to leak into the bloodstream and potentially trigger endotoxemia, a potentially life-threatening inflammatory response that can occur with heat exhaustion and heatstroke.

Heatstroke deaths may be massively undercounted—perhaps by a factor of 10

One often-cited average estimate of annual American heat deaths—roughly 1,200 per year—is based on death certificate data, but it may be a significant undercount because heat kills through cardiovascular, kidney, and respiratory causes that are more likely to be cited on those documents. (Separate analysis that looked at data from 1999 to 2023 found that the highest number, in 2023, was 2325.)

Sickle cell trait can put people at elevated risk of heat-related illness

This hereditary blood disorder affects the shape and function of red blood cells. A US military study found that among recruits the incidence rate of exertional heat-related illness was 48% higher among those who had sickle cell trait as compared to those without. Easing into intense exercise and gradually increasing exertional frequency and intensity is recommended.

Heat-related complications are of greater concern for distance runners than cardiac threats

Analysis of more than 130,000 runners in Tel Aviv events during a seven-year period indicated that the runners were 10 times more likely to experience heatstroke than serious cardiac problems. Scientists suggest that runners should take 10 to 14 days to acclimate to a hot climate before tackling a serious run.

Certain medications that affect blood flow or mood boost the risk of heatstroke

Drugs that narrow blood vessels, beta blockers that regulate blood pressure, diuretics, antidepressants, and antipsychotics can all affect the body's ability to regulate its internal body temperature, and so individuals taking these medications need to take special care in extreme heat and when exercising in hot conditions.

Heatstroke treatment guidelines were built almost exclusively on research in men

Protocols for the standard treatment recommendation for heatstroke—whole-body cold water immersion—were built based on studies almost entirely in men. The research wasn't replicated in women, who typically cool faster than men during cold water immersion, raising questions about standard protocol safety for women, due to the risk of overcooling.

Health workers may cool body temperatures with convection cooling

That's spraying a patient with water and putting fans over them. Cooling the body by removing clothing and placing cold water and ice packs—and not blocking evaporation—are essential cooling steps.

Extreme heat puts people at risk of developing kidney stones

It's essential to remain hydrated in summer weather to keep your body healthy, but one reason is to help dilute minerals that naturally build up if they aren't excreted in our water-fueled urine. Doctors recommend people generally drink 64 ounces of water a day and also eat foods with salt to help ward off dehydration.

What is a heat dome?

The world is seeing regular heat waves with multiple causes, including so-called "heat domes," a term rising in use in recent years. A heat dome occurs when the atmosphere traps hot ocean air like a lid or cap, creating stifling conditions and resulting in extended periods of heat. See an illustration of this phenomenon and read how it works with this brief explainer.

How to survive hypothermia

Hypothermia is a deadly risk for those living in cold areas, causing around 1,500 deaths a year in the United States. Stay safe with tips from this article, which cites research papers to help prevent and treat the condition. Take note of the best fabric to wear when cold weather hits—not cotton but wool.

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Endurance art strains and exhausts the body

Artists like Marina Abramović are known for testing the limits of human endurance. Endurance art can involve carrying heavy objects or posing uncomfortably for long durations. (This resource contains some artistic depictions of violence.)

Grief can trigger broken heart syndrome

Broken heart syndrome—stress cardiomyopathy—involves sudden, intense chest pain that is often mistaken for a heart attack. The condition, which affects part of the heart, briefly interrupts the way the heart pumps blood.

Olympians view sleep as a performance tool, prioritizing routine and environment

Elite athletes emphasize consistent sleep routines, dark and cool environments, the well-placed nap, and tools like eye masks, white noise machines, and supplements like melatonin (particularly for jet lag). This priority belies a core principle: recovery and performance are inseparable. Read more ways Olympians "sleepmaxx" here.

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