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Clinicians should view exertional heat illness (EHI) as a spectrum ranging from heat exhaustion to exertional heat stroke (EHS), with EHS defined by central nervous system dysfunction, severe hyperthermia, and organ injury. However, clinical progression is not always linear as EHI can escalate abruptly to EHS.
EHI develops when metabolic heat production exceeds the body’s ability to dissipate heat through thermoregulation mechanisms such as cutaneous vasodilation and cardiovascular adjustments. As thermal strain intensifies, organ hypoperfusion, direct thermal injury to tissues, and activation of an inflammatory cascade may occur, leading to multiorgan dysfunction.
EHI can occur even in temperate environments when exercise intensity…