What is the diagnosis for acute nausea, dizziness, and feeling hot?

Acute Nausea, Dizziness, and Feeling Hot: Diagnosis and Management

Primary Diagnosis

Heat exhaustion is the most likely diagnosis when a patient presents with acute nausea, dizziness, and feeling hot, and requires immediate cooling measures and hydration. 1

Immediate Assessment Algorithm

Step 1: Check Mental Status (Critical First Step)

• If mental status is altered or confused: This indicates potential heat stroke (core temperature ≥104°F/40°C) or other life-threatening conditions requiring emergency activation 2, 1
• If mental status is preserved: Proceed with heat exhaustion management while monitoring closely 2

Step 2: Assess Core Temperature When Feasible

• Rectal temperature should be checked by trained personnel if available 2
• Temperature >104°F (40°C) with altered mental status = heat stroke requiring emergency cooling 2, 1
• Temperature <104°F with preserved mental status = likely heat exhaustion 1

Step 3: Evaluate for Red Flags

Check immediately for these life-threatening presentations:

• Recent heat/exercise exposure with inability to cool down: Heat stroke risk 3
• Collapse or severe central nervous system dysfunction: Activate emergency services immediately 2, 1
• Elderly patient with atypical presentation: Consider sepsis—obtain blood cultures, urinalysis, CBC before antibiotics 3
• Symptoms worsening despite first aid: Seek emergency care 1

Immediate Management Protocol

For Heat Exhaustion (Preserved Mental Status)

1. Move to cool environment immediately and remove excess clothing 1
2. Cool the patient with cool water spray or ice packs to neck, axillae, and groin 2, 1
3. Provide oral fluids if patient can swallow—preferably 4-9% carbohydrate-electrolyte drink over water alone 1
4. Elevate legs if postural hypotension is contributing 2
5. Monitor for 10-15 minutes and reassess mental status 2, 1

For Heat Stroke (Altered Mental Status)

1. Activate emergency services immediately 2, 1
2. Begin rapid cooling without delay—do not wait for temperature verification 2
3. Cold or ice-water immersion is the preferred method until core temperature reaches 101.4°F (38.6°C) 2
4. Alternative cooling: Apply ice packs to neck, axillae, groin and rotate ice-water-soaked towels to all body areas 2
5. Six-person team required for safe ice submersion due to potential combativeness or somnolence 2

Differential Diagnosis Considerations

Cyclic Vomiting Syndrome (CVS)

• Prodromal symptoms include feeling hot or cold, nausea, mental fog, anxiety, and diaphoresis 2, 3
• Key distinguishing feature: Episodes are recurrent and stereotypical, not isolated acute presentations 2
• Hot water bathing provides temporary relief in 48% of CVS patients 2

Infection/Sepsis (Especially in Elderly)

• Temperature dysregulation with nausea can indicate serious infection 3
• Urgent workup required: Core temperature, CBC with differential, comprehensive metabolic panel, blood cultures, urinalysis 3
• Do not delay antibiotics if infection suspected—initiate broad-spectrum coverage after cultures obtained 3

Orthostatic Hypotension/Presyncope

• Common cause of dizziness with preserved mental status 4
• Simple leg elevation resolves symptoms if this is the primary cause 2

Critical Pitfalls to Avoid

1. Delaying cooling while waiting for temperature verification—begin cooling immediately if clinical suspicion is high 2, 1
2. Providing only water for rehydration—electrolyte-supplemented beverages are superior for exertional dehydration 1
3. Allowing return to activity same day—anyone with exertional heat illness must not return to activity for remainder of session 2, 1
4. Cooling too aggressively—stop cooling at 101.4°F (38.6°C) to prevent hypothermia 2
5. Missing sepsis in elderly patients—atypical presentations with temperature dysregulation require immediate infection workup 3
6. Ignoring early warning signs—flushed face, hyperventilation, headache, tingling arms, piloerection, chilliness, incoordination signal evolving heat illness 5

When to Activate Emergency Services

Call 911 immediately for: 2, 1

• Any altered mental status, delirium, convulsions, or coma
• Collapse during or after physical activity in heat
• Moderate to severe central nervous system dysfunction
• Symptoms worsening despite 10-15 minutes of appropriate first aid