Differential Diagnosis

Differential diagnosis in suspected heat stroke
Sepsis (e.g. pneumonia, urinary tract infection, meningitis, endocarditis)
Tropical infection (e.g. malaria, typhoid)
Endocrinopathy (e.g. thyroid storm, phaeochromocytoma)
Status epilepticus
Intracerebral haemorrhage, especially thalamic haemorrhage
Alcohol withdrawal
Anticholinergic toxicity
Salicylate toxicity
Illicit drug use (e.g. cocaine, amphetamine)
Neuroleptic malignant syndrome
Malignant hyperpyrexia

A patient may present with heat stroke and a body temperature below 40.0°C, particularly if cooling has occurred during transport to hospital.

A wide variety of conditions may present with elevated temperature.

Paying attention to the circumstances of a patient's admission and to their past medical and drug history is necessary to avoid misdiagnosis.

In particular, sepsis, various endocrinopathies and drug reactions may present with hyperpyrexia. Table 1 lists the main differential diagnoses for suspected heat stroke.

Heat stroke can coexist with many of the diagnoses listed, particularly in the elderly. For example:

  • An elderly person with urinary sepsis may also develop heat stroke during a period of hot weather
  • An alcoholic may collapse in a hot environment while intoxicated and present later with features of heat stroke and alcohol withdrawal
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