Environmental Pearls

Heat stroke is defined by environmentally and/or exertionally induced core body temperature above 40°C (104°F) accompanied by CNS dysfunction (delirium, convulsions, or coma).

Although anhidrosis is nearly universal in those with classic heat stroke, it is only present in approximately half of those with exertional heat stroke.

Interestingly, splanchnic hypoperfusion, a result of preferential shifting of blood to the skin and muscles during strenuous exercise or hyperthermia, can fuel the inflammatory response. Splanchnic hypoperfusion is thought to alter the immunologic and barrier functions of the intestines, leading to leakage of endotoxins and increased production of cytokines.

Although pyrogenic cytokines are implicated in the pathophysiology of hyperthermia, the role of antipyretic agents such as acetaminophen has not been studied, and they currently have no role in the treatment of heat stroke.