What are the treatment options for heat exhaustion symptoms?

Treatment of Heat Exhaustion

Immediately move the person to a cool environment, remove excess clothing, provide cool fluids with electrolytes if they can swallow, and cool them with water spray or wet towels—this prevents progression to life-threatening heat stroke. 1

Immediate Management Steps

Environmental Modifications

• Move the victim to a cool, shaded place immediately to stop further heat exposure 2, 1
• Remove as much clothing as possible to facilitate heat dissipation 1
• Limit all physical exertion—the person must not return to activity for the remainder of that session 2

Cooling Interventions

• Apply cool water spray to the skin and use fans or moving air to enhance evaporative cooling 1
• Use wet towels or cold packs applied to the skin for additional cooling 3
• In more extreme situations, consider cold showers or aggressive application of wet towels 4
• Continue cooling for 10-15 minutes while monitoring clinical response 2

Fluid Replacement

• Provide cool fluids containing both carbohydrates and electrolytes if the person is alert and can swallow 2, 1
• A 4-9% carbohydrate-electrolyte drink is preferable to water alone for exertional dehydration 1
• For prolonged exercise (≥1 hour) or extensive sweat loss, electrolyte-supplemented beverages emphasizing sodium are warranted 2
• Typical fluid needs: 100-250 mL every 20 minutes for children 9-12 years old, up to 1.0-1.5 L per hour for adolescents 2

When Intravenous Fluids Are Needed

• If the person cannot swallow or symptoms are severe, intravenous hydration may be necessary 5
• Monitor serum sodium levels closely during IV rehydration to prevent cerebral edema 5

Critical Distinction: Heat Exhaustion vs. Heat Stroke

Heat exhaustion is characterized by core body temperature less than 104°F (40°C) with symptoms including weakness, dizziness, nausea, syncope, headache, fatigue, and heavy sweating—but without central nervous system dysfunction 2, 1. This is the key differentiator from heat stroke.

Activate emergency medical services immediately if:

• The person collapses or exhibits altered mental status, confusion, delirium, or seizures 2, 1
• Core temperature exceeds 104°F (40°C), indicating heat stroke 2
• Symptoms worsen despite first aid measures 1
• The person cannot participate in their own care 3

Special Considerations for Children

• Children experiencing exertional heat illness should not return to any physical activity for the remainder of the current session 2
• Provide hydration while awaiting medical assistance if the child is alert enough to ingest fluid 2
• Emergency protocols should be in place ahead of time, especially for children wearing uniforms or protective equipment that contributes to heat storage 2

Common Pitfalls to Avoid

• Do not delay treatment waiting for temperature verification—if clinical signs suggest heat illness, begin cooling immediately 2
• Do not allow the person to resume exercise until all symptoms have completely resolved 2, 1
• Avoid the "seek not, find not" problem—actively look for early warning signs including flushed face, hyperventilation, tingling arms, piloerection, chilliness, and incoordination 6
• Do not confuse initial hyperventilation and confusion with other conditions—heat illness can mimic other emergencies 6

Prevention Strategies

• Adjust exercise intensity when temperature exceeds 70°F 1
• Drink adequate fluids before, during, and after exercise—do not rely on thirst alone 6
• Allow 12-14 days for gradual heat acclimatization 1
• Wear loose-fitting, porous clothing 1
• Increase dietary salt intake for those exercising for hours in the sun 6