Spectrum — cramps & exhaustion (**Heat cramps:** painful muscle spasms, normothermic or mildly elevated temp — rest, oral fluids/electrolytes, gentle stretching · **Heat exhaustion:** volume depletion, temp may be elevated but **CNS intact** — oral/IV rehydration, cooling if hyperthermic (AAP, WHO, WMS, ERC))
Initial assessment (ABCDE; core temperature (rectal/esophageal preferred); mental status must be **normal** for exhaustion pathway — if CNS dysfunction + hyperthermia → heat stroke variant (AAP, WMS, ERC))
Max 500 mg/dose · Duration: Over 1–4 h · **5–10 mL/kg** ORS over 30–60 min, then maintenance per thirst/dehydration severity — add electrolytes; monitor mental status and urine output (WHO, AAP, WMS)
• **Heat cramps:** rest, oral fluids/electrolytes, gentle stretching of affected muscles; salt-containing fluids if no contraindication; usually resolves with rehydration — no hospitalization if improving (AAP, WMS).
• **Heat exhaustion:** move to cool environment; remove excess clothing; oral rehydration if tolerating — **ORS or sports drink** with electrolytes; IV fluids if vomiting or unable to tolerate oral (AAP, WHO, WMS).
• **Cooling (if hyperthermic but CNS intact):** evaporative cooling — fan + spray/mist water on exposed skin; cool packs to neck/axillae; target gradual reduction; stop active cooling at ~38–39°C to avoid overshoot (WMS, ERC).
• **Distinguish from heat stroke:** heat stroke = core temp typically **≥40°C (104°F)** WITH **CNS dysfunction** (confusion, seizures, coma) — if present, escalate to heat stroke pathway immediately (AAP, WMS, ERC).
• **Risk factors:** exertion, hot humid environment, inadequate acclimatization, obesity, medications (anticholinergics, stimulants), heavy clothing (AAP, WMS).
Enter weight on Kids to calculate doses
Hospital admission + observation • procedure
Duration: Inpatient · Admit if not improving with oral rehydration, persistent electrolyte abnormalities, rhabdomyolysis, AKI, or unreliable follow-up (AAP, WHO, WMS)
