Classic heatstroke can be prevented by publicizing community heat-wave alerts, providing cool environments for people at risk, maintaining adequate hydration, and promoting judicious use of diuretics, tranquilizers, antidepressants, and anticholinergic medications. The second form of heatstroke is triggered by exercising in a warm, humid environment. The major pathophysiological mechanism responsible for exertional heatstroke is increased heat production from exercising skeletal muscles. Patients who suffer exertional heatstroke do not appear to have intrinsic metabolic defects of their skeletal muscles or abnormalities of their thermoregulatory mechanisms. Whereas classic heatstroke occurs in outbreaks, exertional heatstroke occurs sporadically and typically affects young, healthy individuals who engage in strenuous exercise.
Exertional heatstroke is much more common in men than in women.
In addition to ambient weather conditions and muscular exertion, predisposing factors include inappropriately heavy clothing, exposure to direct sunlight, dehydration, lack of cardiovascular conditioning, and lack of acclimatization to heat. Because all of these factors can be anticipated and corrected, exertional heatstroke is preventable. Despite differences in pathophysiology and epidemiology, the major manifestations of the classic and exertional heatstroke syndromes are similar. Disordered mentation is no less common and may span a spectrum ranging from confusion and lethargy to delirium, stupor, coma, and seizures. Despite the dramatic central nervous system manifestation of extreme hyperthermia, most patients who survive do not exhibit neurologic impairment.