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