Intended for healthcare professionals

Practice Practice Pointer

Heat illnesses in clinical practice

BMJ 2022; 378 doi: (Published 09 August 2022) Cite this as: BMJ 2022;378:e070762
  1. C Sorensen, associate professor1 2,
  2. C Howard, associate professor, community research fellow in planetary health34,
  3. P Prabhakaran, head, environmental health, senior research scientist56,
  4. G Horton, senior lecturer in medical education and general practice7,
  5. R Basu, chief of air and climate epidemiology section8
  1. 1Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
  2. 2Department of Emergency Medicine, Columbia Irving Medical Center, New York, NY, USA
  3. 3Cumming School of Medicine, University of Calgary, Calgary, Canada
  4. 4Dahdaleh Institute for Global Health Research, York University, Toronto, Canada
  5. 5Centre for Environmental Health, Public Health Foundation of India, India
  6. 6Centre for Chronic Disease Control, New Delhi, India
  7. 7School of Medicine and Public Health, University of Newcastle, Australia
  8. 8Office of Environmental Health Hazard Assessment, Air and Climate Epidemiology Section, Oakland, CA, USA
  1. Correspondence to cjs2282{at}

What you need to know

  • Increased frequency and intensity of heatwaves are leading to greater incidence of heat illness and exacerbations of heat sensitive disease (eg, cardiac, respiratory, renal, and mental health conditions) globally

  • People over 65, pregnant women, infants, young children, athletes, outdoor workers, those living in urban environments, patients with comorbidities, and those on certain medications are particularly at risk of heat related illness

  • The foundations of managing heat illnesses include recognising heat as a cause, removing patients from hot environments, and rapid cooling

Case studies

A 14 year old boy is brought by his family to the emergency department after collapsing on the field during a high school football practice. The region has been under a heatwave alert for the past three days, with daytime temperatures reaching 40°C and night time low temperatures of 32°C. The boy’s coach saw him struggling during running exercises, then collapse, and have seizure like activity. The boy’s mother says he has no underlying medical conditions and was feeling well before the practice. On arrival at hospital, his heart rate is 145 beats/min, blood pressure 100/60 mm Hg, and his rectal temperature is 40°C. He is breathing spontaneously and responding to painful stimuli. Heat stroke is identified immediately. The patient is intubated for airway protection, sedated with benzodiazepines, and rapidly cooled with cold water immersion and chilled IV fluids. His temperature comes down to 37.5°C within 30 minutes. On hospital day 1, he is found to have an acute kidney injury and a mild liver injury, which rapidly improve by day 2. On day 3, he is extubated and has an excellent neurological recovery.

A 55 year old woman who works as a store clerk is brought to hospital because she appears confused. She has schizoaffective disorder which has been well managed on clozapine. There is a heatwave in …

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