Cold IV Infusion as a Heat Stroke Treatment

Intravenous (IV) infusion of cold fluids may be considered a suitable method of cooling a heat stroke victim by some medical providers, especially during transport. But what does the evidence say?

In short, the evidence supports "cool first, transport second", given the 30-minute time frame to lower core temperature below 39ºC. A minimal core temperature cooling rate of 0.78ºC per 10 minutes is generally required to achieve that, and is therefore deemed acceptable (McDermott et al., 2009). For cold IV to be deemed a suitable heat stroke treatment, it must be evaluated against the minimal acceptable cooling rate irrespective of its ability to be performed during transport. On that basis, the three studies summarised by Table 1 reported modest cooling rates that were either at the low end of the acceptable range or deemed unacceptable. Infusing 4 v 22ºC improved the core temperature cooling rate by 14.3% (0.72 v 0.63ºC per 10 minutes), but it remained in the unacceptable range. Overall, based upon the published data, cold IV infusion appears inadequate as a stand-alone or primary heat stroke treatment, even when infusing 2L of fluid.

Table 1. Summary of three studies assessing intravenous infusion to rapidly lowering core temperature

That conclusion is supported by the Wilderness Medical Society Clinical Practice Guidelines (2024 update) that state "Cold intravenous fluids may supplement cooling but have not been shown to adequately serve as a primary treatment for heat stroke. We recommend not using cold intravenous fluids as a primary cooling modality for the treatment of heat stroke" (Eifling et al., 2024). Furthermore, the November 2024 Consensus Statement on the Pre-Hospital Management of Exertional Heat Illness November 2024 from the Royal College of Surgeons of Edinburgh state "Current evidence does not support the routine use of IV fluids, cold or otherwise, to reduce core temperature in exertional heat illness patients in a pre-hospital setting” (Hemingway et al, 2025).

The evidence supports alternative cooling methods to IV infusion as the primary heat stroke treatment based upon published cooling rates. Regardless, administering IV fluids is used in some field settings as part of prevention or treeatment of heat stroke (click on video below for an example).

References

Eifling KP, Gaudio FG, Dumke C, Lipman GS, Otten EM, Martin AD, Grissom CK. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update. Wilderness & Environmental Medicine. 2024;35(1_suppl):112S-27S

Hemingway R, Stourton F, Leckie T, Fitzpatrick D, Jones G, Wood F, Boalch A, McNulty-Ackroyd J, Thurgood A, Boulter M, Hartle A, Walter E, Pynn HJ, Kipps C, Stacey MJ. Faculty of Pre-Hospital Care: consensus statement on the prehospital management of exertional heat illness. Emerg Medicine Journal. 2025; ;42(6):390-395

McDermott BP, Atkins WC. Whole-body cooling effectiveness of cold intravenous saline following exercise hyperthermia: A randomized trial. The American Journal of Emergency Medicine. 2023; 72:188-92

McDermott BP, Casa DJ, Ganio MS, Lopez RM, Yeargin SW, Armstrong LE, Maresh CM. Acute whole-body cooling for exercise-induced hyperthermia: a systematic review. J Athl Train. 2009 Jan-Feb;44(1):84-93.

Morrison KE, Desai N, McGuigan C, Lennon M, Godek SF. Effects of intravenous cold saline on hyperthermic athletes representative of large football players and small endurance runners. Clinical Journal of Sport Medicine. 2018; 28(6):493-9

Sinclair WH, Rudzki SJ, Leicht AS, Fogarty AL, Winter SK, Patterson MJ. Efficacy of field treatments to reduce body core temperature in hyperthermic subjects. Medicine and Science in Sports and Exercise. 2009; 41(11):1984-90