Heat exhaustion responds to cooling and fluids. Heatstroke is a 999 emergency, and confusion is the dividing line.
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Heat exhaustion and heatstroke are two points on the same scale, and telling them apart is the single most useful thing on this page.
Heat exhaustion is the body struggling to cope with heat. You feel awful — hot, sweaty, weak, headachy, nauseated — but you are still yourself. It responds to cooling and fluids and resolves within about half an hour.
Heatstroke is when the body's temperature control has failed. The defining feature is a change in how someone is thinking or behaving — confusion, disorientation, slurred speech, seizures, loss of consciousness. That is organ damage happening, and it is a 999 emergency.
The person with heatstroke often stops sweating and the skin becomes hot and dry, though this is not reliable — in exertional heatstroke from exercise, they may still be drenched.
This is frequently overlooked, and it matters in a heatwave:
This is a clinical diagnosis made on the picture in front of you, not on a test — the story of heat exposure plus the symptoms.
The one thing worth measuring is the temperature, and more importantly the mental state. Someone who is oriented and making sense has heat exhaustion; someone who is confused has heatstroke until proven otherwise.
In hospital, blood tests look for the complications rather than to confirm the diagnosis — kidney injury, muscle breakdown, clotting problems and liver damage, all of which heatstroke can cause.
After a significant episode, kidney function is worth checking, because acute kidney injury from dehydration and muscle breakdown is common and often silent.
If someone is confused, do not book an appointment. Call 999.
Heat exhaustion is managed at home, and the treatment is immediate rather than medical:
If they are not substantially better after 30 minutes of proper cooling, that is the trigger to call 999.
What we cannot do is assess someone who is acutely unwell with heat illness. That needs hands, a thermometer and, if it is heatstroke, an ambulance.
While waiting for the ambulance, keep cooling them. Cool water over the skin, fanning, ice packs to armpits, neck and groin. Do not give fluids to anyone who is drowsy or confused — they may choke.
Older people living alone, and anyone with dementia, heart disease or on diuretics, are at the highest risk and least likely to recognise it. A phone call in a heatwave is a genuinely useful intervention.
Never leave anyone — or any animal — in a parked car, even briefly and even with windows open.
This is an NHS matter, and there is no private shortcut worth paying for. Heatstroke is an emergency treated in hospital, and heat exhaustion is treated at home with cooling and fluids that cost nothing.
Rehydration salts from a pharmacy cost a few pounds and are more effective than water alone after heavy sweating.
Where a private consultation has genuine value:
The NHS Heatwave Plan and Met Office heat alerts are free, and worth paying attention to if you or someone you care for is in a risk group.
This page follows NHS guidance on heat exhaustion and heatstroke and the UK Health Security Agency Adverse Weather and Health Plan, which sets out the heat-health alert system and the groups at highest risk.
The 30-minute rule and the emphasis on altered mental state as the dividing line reflect standard UK emergency guidance.
Cold water immersion for exertional heatstroke is supported by sports and military medicine evidence, and is distinguished here from the approach used in classic heatstroke in frail or elderly people.
The medication risk list reflects UKHSA heatwave advice on drugs affecting thermoregulation, fluid balance and renal function.
Confusion. Someone with heat exhaustion feels dreadful but is still themselves. Anyone who is disoriented, behaving oddly or slurring their speech has heatstroke until proven otherwise — call 999.
Thirty minutes. If they are not substantially better after half an hour of proper cooling and fluids, that is your signal to call 999.
For exertional heatstroke in a young, otherwise healthy person, rapid cold water immersion is the most effective cooling method and is used in sports medicine. For an elderly or frail person, use cool water on the skin, fans and ice packs instead — and in either case, call 999 first.
Yes, and it is commonly missed. Diuretics, some antidepressants and antipsychotics, anticholinergics and beta blockers all raise the risk. Worth reviewing before a heatwave rather than during one.
Not reliably. Classic heatstroke often stops sweating, but heatstroke brought on by exercise frequently does not. Judge it on the mental state, not the skin.
Water for mild symptoms; oral rehydration salts if there has been heavy sweating or vomiting. Not alcohol, and not large amounts of very sugary drinks.
Yes — it can injure the kidneys, liver, muscle and brain, which is why the speed of cooling matters so much. Most people who are cooled quickly recover fully.
September 8, 2026
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Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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