Controversies in exertional heat stroke diagnosis, prevention, and treatment

Orlando Laitano, Lisa R. Leon, William O. Roberts, Michael N. Sawka

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


During the past several decades, the incidence of exertional heat stroke (EHS) has increased dramatically. Despite an improved understanding of this syndrome, numerous controversies still exist within the scientific and health professions regarding diagnosis, pathophysiology, risk factors, treatment, and return to physical activity. This review examines the following eight controversies: 1) reliance on core temperature for diagnosing and assessing severity of EHS; 2) hypothalamic damage induces heat stroke and this mediates "thermoregulatory failure" during the immediate recovery period; 3) EHS is a predictable condition primarily resulting from overwhelming heat stress; 4) heat-induced endotoxemia mediates systemic inflammatory response syndrome in all EHS cases; 5) nonsteroidal anti-inflammatory drugs for EHS prevention; 6) EHS shares similar mechanisms with malignant hyperthermia; 7) cooling to a specific body core temperature during treatment for EHS; and 8) return to physical activity based on physiological responses to a singleexercise heat tolerance test. In this review, we present and discuss the origins and the evidence for each controversy and propose next steps to resolve the misconception.

Original languageEnglish (US)
Pages (from-to)1338-1348
Number of pages11
JournalJournal of applied physiology
Issue number5
StatePublished - 2019

Bibliographical note

Publisher Copyright:
Copyright © 2019 the American Physiological Society.


  • Cooling
  • Endotoxin
  • Exercise
  • Heat strain
  • Heat stress
  • Serious heat illness


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