Hot weather advice

Work in progress

General information based on current NHS and UKHSA guidance. Not individualised medical advice. If you are worried about someone, call 111, or 999 if there are signs of heatstroke.

A side project, put together from published guidance and still being worked on. No clinician has checked it. Every card links its sources, so read those and talk to your GP or pharmacist. Never change a prescribed medicine because of anything here.

What helps

Believed, but not true

Warning signs

Heat exhaustion

  • tiredness
  • dizziness
  • headache
  • feeling sick or being sick
  • excessive sweating, with skin becoming pale and clammy
  • cramps in the arms, legs and stomach
  • a high temperature
  • being very thirsty
  • weakness

What to do

  • Move the person to a cool place.
  • Remove all unnecessary clothing, such as a jacket or socks.
  • Get them to drink plenty of water. An isotonic sports drink is also fine.
  • Cool their skin: spray or sponge them with cool water and fan them. Cold packs wrapped in a cloth and put under the armpits or on the neck also help.
  • Stay with them until they are better. Someone with heat exhaustion should start to feel better within 30 minutes.
  • Call 999 if they are no better after 30 minutes, or if any sign of heatstroke appears.

Heatstroke: call 999

  • a very high temperature
  • hot skin that is not sweating, and which may look red (this can be harder to see on brown and black skin)
  • fast breathing and a fast heartbeat
  • confusion and restlessness
  • a lack of coordination
  • a seizure or fit
  • loss of consciousness

What to do

  • Call 999 straight away. Heatstroke is a medical emergency.
  • While waiting, move the person to a cool place and remove unnecessary clothing.
  • Cool them as fast as you can: cold water over the skin, cold wet towels changed frequently, cold packs under the armpits and on the neck, and fan them. Immersion in cold water is the fastest method if that is safely available.
  • Do not give anything to drink if they are confused or drowsy, because of the risk of choking.
  • Keep cooling until help arrives, and put them in the recovery position if they lose consciousness.

Call 999 if

  • any sign of heatstroke: very high temperature, hot skin that is not sweating, confusion, lack of coordination, seizure, loss of consciousness
  • no improvement after 30 minutes of cooling and fluids for heat exhaustion
  • seizure, collapse or someone you cannot rouse
  • severe breathlessness or fast deep breathing

Call 111 if

  • heat exhaustion symptoms you are struggling to treat
  • you are unsure how serious something is
  • questions about pausing or restarting medicines during hot weather or a dehydrating illness
  • much reduced urine output, or symptoms suggesting kidney problems, without emergency features
Other things to look out for
  • hyponatraemia (low blood sodium from drinking too much)

    • headache, nausea and vomiting
    • bloating, or rings and watch feeling tight
    • confusion, irritability or odd behaviour
    • gaining weight during long exercise instead of losing it
    • in severe cases, seizures, breathlessness or loss of consciousness
    • Stop drinking plain water. This is the opposite of what heat exhaustion needs, which is why it is easy to get wrong.
    • For mild symptoms, have something salty to eat or an oral rehydration or isotonic drink.
    • Seek urgent medical help for confusion, seizures or breathlessness, and say that a lot of water has been drunk.
  • acute kidney injury (AKI)

    • passing much less urine than usual, or none
    • very dark urine
    • feeling sick, being sick, or loss of appetite
    • tiredness and confusion
    • swollen ankles, feet or hands, or breathlessness
    • often there are few symptoms early on, which is why medicine combinations matter
    • Contact your GP or 111 urgently. AKI is diagnosed on a blood test.
    • Follow your sick day rules if you have them, which usually means pausing diuretics, ACE inhibitors or ARBs, SGLT2 inhibitors, metformin and NSAIDs during a dehydrating illness.
    • Avoid ibuprofen and other NSAIDs, and keep drinking unless you have been told to restrict fluids.
    • Call 999 for confusion, severe breathlessness or collapse.
  • diabetic ketoacidosis (DKA)

    • feeling very thirsty and passing a lot of urine
    • feeling sick, being sick, or tummy pain
    • deep or fast breathing
    • breath smelling sweet or fruity, like pear drops
    • drowsiness and confusion
    • on SGLT2 inhibitors, glucose can be normal, so a normal reading does not rule it out
    • Check ketones if you have a meter, in blood or urine.
    • Seek urgent medical help for raised ketones, vomiting, fast breathing or drowsiness, even if glucose looks normal.
    • Call 999 for drowsiness, confusion or persistent vomiting.
    • Tell staff if you take an SGLT2 inhibitor, because euglycaemic DKA is easily missed.
  • lithium toxicity

    • coarse trembling of the hands, worse than usual
    • vomiting or diarrhoea
    • unsteadiness on the feet
    • slurred speech
    • muscle twitching or weakness
    • drowsiness, confusion or blurred vision
    • Seek same-day medical advice and ask about an urgent lithium level.
    • Say if you have been sweating heavily, had vomiting or diarrhoea, or started an NSAID or diuretic.
    • Keep sipping fluids while you get advice, and do not adjust the dose yourself.
    • Call 999 for seizures, marked confusion or loss of consciousness.
  • lactic acidosis (metformin)

    • deep or fast breathing
    • severe muscle aches or cramps
    • tummy pain, feeling sick or being sick
    • unusual tiredness or sleepiness
    • feeling cold, especially in the hands and feet
    • Stop metformin and seek urgent medical advice.
    • Call 999 for fast breathing, severe drowsiness or collapse.
    • Mention hot weather, heavy sweating, vomiting or diarrhoea, since these are the usual triggers.
  • low blood glucose (hypoglycaemia) in the heat

    • shakiness, sweating and a pounding heart
    • hunger, tiredness and dizziness
    • difficulty concentrating, irritability or confusion
    • these overlap heavily with heat exhaustion, so test rather than assume
    • Test blood glucose if you can.
    • Take fast-acting glucose, then a longer-acting carbohydrate once recovered.
    • Check glucose more often in hot weather, since warm skin speeds insulin absorption.
    • Call 999 for seizures or loss of consciousness.