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Common Factors Contributing to Heat Disorders

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Condition	Examples
Dehydration
Medications and substances	Alcohol, diuretics, lithium, tricyclic antidepressants, laxativesAlcohol, diuretics, lithium, tricyclic antidepressants, laxatives
Inadequate fluid intake	—
Excess heat gain or production
Certain disorders	Hyperthyroidism Infections Malignant hyperthermia Neuroleptic malignant syndrome Seizures Serotonin syndrome
High environmental temperatures	Increasing frequency of heat waves
Stimulant medications and substances	Amphetamines Cocaine Methylenedioxymethamphetamine (MDMA, or Ecstasy) Monoamine oxidase inhibitors Phencyclidine (PCP)
Strenuous exertion	Exercise Physical labor
Withdrawal from certain medications and substances	Alcohol Opioids
Impaired cooling
Heavy clothing	Protective gear for workers and athletes (eg, football pads)
High environmental temperatures	—
High humidity	—
Obesity and/or poor cardiovascular fitness	—
Extremes of age	—
Medications impairing thermoregulatory mechanisms	Antipsychotics, selective serotonin uptake inhibitors, calcium channel blockers
Impaired sweating*
Anticholinergic medications	Antihistamines Antiparkinsonian medications AtropineAtropine Phenothiazines ScopolamineScopolamine
Cystic fibrosis	—
Skin disorders	Burn scars, extensive Eczema, extensive Heat rash Psoriasis, extensive Systemic sclerosis
* Impaired sweating is a cause of impaired cooling. Sorensen C, Hess J. Treatment and Prevention of Heat-Related Illness. N Engl J Med. 2022;387(15):1404-1413. doi:10.1056/NEJMcp2210623