Home care is appropriate for mild forms of heat exhaustion. For mild cases of heat exhaustion, it is advised to rest in a cool, shaded area. Give cool fluids such as sports drinks that will replace the salt that has been lost. Salty snacks are appropriate, as tolerated. Loosen or remove clothing. Do not use an alcohol rub. Do not give any beverages containing alcohol or caffeine.

Heat stroke is a medical emergency. After the patient has been removed from the hot environment, intravenous fluids are administered. Give supplemental oxygen and assisted ventilation, as indicated. Initiate cooling measures with any resources available. Evaporative cooling is the preferred cooling method because it is safe, effective, easily accomplished, and well tolerated. An ideal goal is to drop the patient’s core temperature by 0.2°C/min. Undress the patient, spray with tepid (not cold) water, and cool by large fans to maximise evaporative heat loss. Apply ice packs to the patient’s neck, axillae and groin. Alternatively, cover the patient with a wet sheet. Although ice water or slush immersion is effective at rapidly lowering body temperature, it is associated with more complications than evaporative cooling and generally is not recommended. Immersion in ice water causes peripheral vasoconstriction, shunts blood away from the periphery, and actually leads to less heat dissipation. It is also uncomfortable for the patient, limits access for cardiac and vital sign monitoring, and may result in hypothermic overshoot. The water deficit is best corrected slowly (one half of the total water depletion replaced in the first 3-6 h, with the remainder replaced over the next 6-9 h). Other modalities include ice water gastric lavage, ice water rectal lavage, ice water peritoneal lavage, and cardiopulmonary bypass. No drugs significantly reduce core temperature in patients with heat illness.

Avoid anticholinergics (decrease sweating), alpha-adrenergic agonists (increase peripheral resistance without increasing cardiac output) and antipyretics. An increased hypothalamic set point is not the aetiology of the increased body temperature; thus, antipyretics do not help decrease body temperature. Salicylates can worsen coagulopathies, and acetaminophen in large doses can worsen hepatic damage. Strenuous exertion in a very hot environment or in an inadequately ventilated space should be avoided, and heavy insulating clothing should not be worn. If exertion in a hot environment is unavoidable, fluid and electrolytes (often lost imperceptibly in very hot, very dry air) should be replaced by frequently drinking fluids slightly salty to taste (i.e. near isotonic), and evaporation, which helps keep the skin cool, should be facilitated by wearing open mesh clothing or using fans. Thirst is a poor indicator of dehydration. During strenuous exercise, fluids should be drunk every hour regardless of thirst. Salt tablets, which are less desirable than lightly salted beverages and foods, should not be taken unless large amounts of fluids are consumed.