Every May to September, Pakistani hospitals fill up with heat-related patients. Karachi’s Civil Hospital alone reports 70 to 80 such cases daily during peak heatwaves, according to a 2025 Express Tribune report. Many of these patients arrived too late because a family member couldn’t tell the difference between heat exhaustion and heatstroke.
The two conditions sit on the same spectrum of heat-related illness, but one is manageable at home and the other is a life-threatening emergency. Getting that distinction wrong can cost a life. Pakistan’s outdoor workers, rickshaw drivers, construction labourers, and students walking to school in June heat are all at risk every single day.
This guide explains how to tell the two apart, what to do in the first 30 minutes, and when to call for help.
گرمی لگنا اور لو لگنا میں فرق
گرمی لگنا (heat exhaustion) ایک ایسی کیفیت ہے جس میں جسم پسینے کے ذریعے پانی اور نمک کھو دیتا ہے، مگر ذہنی حالت عام رہتی ہے۔ لو لگنا (heatstroke) اس سے کہیں زیادہ خطرناک ہے، کیونکہ اس میں جسم کا درجہ حرارت 40 ڈگری سیلسیس سے اوپر چلا جاتا ہے اور دماغ متاثر ہونے لگتا ہے۔ پاکستان میں گرمیوں کے دوران، خاص طور پر رمضان میں روزے کے وقت اور لوڈشیڈنگ کے دوران، یہ خطرہ کئی گنا بڑھ جاتا ہے۔ گرمی لگنے پر فوری ٹھنڈی جگہ پر جائیں اور ORS پئیں، جبکہ لو لگنے پر فوری ہسپتال جانا ضروری ہے۔
Heat Exhaustion vs Heatstroke: The One-Sentence Difference
Heat exhaustion means your body is struggling to cool down but still trying. Heatstroke means it has stopped trying, and your brain is now at risk.
According to the NHS, heat exhaustion does not usually require emergency medical help if the person cools down within 30 minutes. Heatstroke, by contrast, is a medical emergency that requires immediate intervention.
Symptoms Compared: What to Look For
The single most reliable sign that separates the two is mental state. A person with heat exhaustion can still talk clearly, answer questions, and understand what is happening around them, even if they feel dizzy or weak. A person with heatstroke may be confused, aggressive, slurring their words, or completely unresponsive.
| Feature | Heat Exhaustion | Heatstroke |
|---|---|---|
| Body temperature | Below 40°C (104°F) | Above 40°C (104°F) |
| Sweating | Heavy sweating | Skin may be hot and dry (classic) or still damp (exertional) |
| Skin feel | Cool, pale, clammy | Hot, flushed |
| Mental state | Normal, alert | Confused, aggressive, or unconscious |
| Muscle cramps | Common | May be present |
| Nausea / vomiting | Common | Common |
| Headache | Yes | Yes, often severe |
| Seizures | No | Can occur |
| Emergency? | No, if cooled within 30 min | YES, call for help immediately |
One important nuance: in exertional heatstroke, which happens more often in athletes or outdoor labourers working in extreme heat, the skin may still feel damp rather than dry. Do not use dry skin as the only test. Confusion or any change in behaviour is the red flag that matters most.
Who Is at Highest Risk in Pakistan
Certain groups face a much higher risk of progressing from heat exhaustion to heatstroke. A retrospective study published in the WHO Eastern Mediterranean Health Journal, based on 315 heatstroke patients at Liaquat National Hospital Karachi during the June 2015 heatwave, found that hypertension was the most common concurrent condition, present in 55.9% of patients.
High-risk groups in Pakistan include:
- Outdoor workers (construction, road labour, rickshaw drivers) with no shade breaks
- Elderly adults, especially those living without air conditioning during loadshedding
- Children under 5, whose bodies overheat faster
- People with diabetes, hypertension, or heart disease
- Anyone fasting during Ramadan in peak summer, when temperatures can reach 45°C and fluid intake is restricted for up to 15 hours
- People on certain medications, including blood pressure drugs and diuretics, which affect fluid balance
The Ramadan overlap is a risk that global guides rarely mention. A 2015 NIH/PMC study on Pakistan’s deadly Karachi heatwave noted that the crisis coincided with Ramadan, when fasting meant millions were already mildly dehydrated before going outdoors. If you or a family member is fasting and works outside, check on them every hour.
How to Treat Heat Exhaustion at Home (First 30 Minutes)
If someone is alert, can speak normally, and is sweating heavily, treat for heat exhaustion immediately. Speed matters: most people recover within 30 minutes with the right steps.
- Move them to a cool place. Get indoors, into shade, or near a fan. If there is loadshedding, wet a cotton dupatta or sheet and drape it over them while a hand fan is used. Even shade under a tree is better than standing in direct sun.
- Remove unnecessary clothing. Loosen the collar, remove shoes and socks, and take off any jacket or thick fabric.
- Give ORS or plain water. Oral Rehydration Salts (ORS sachets, available at any Pakistani pharmacy for around Rs 10 to 15 each) replace both water and the electrolytes lost through sweat. Plain water is fine if ORS is unavailable. Do not give caffeinated drinks or chai.
- Apply cool water to the skin. Wet a cloth with cool (not ice-cold) water and press it to the neck, armpits, and wrists. These areas have blood vessels close to the surface and cool the body faster.
- Lay them down with legs slightly raised. This improves blood flow back to the heart and brain.
- Fan them continuously. Even a hand fan or a folded newspaper helps evaporation and speeds cooling.
- Check back in 30 minutes. If they are not improving, or if they become confused, stop responding, or have a seizure, this is no longer heat exhaustion. Treat it as heatstroke and get emergency help.
When Heatstroke Becomes a Medical Emergency
Heatstroke requires hospital treatment. There is no safe home management once the brain is involved. Call for an ambulance or get the person to the nearest emergency room without delay.
While waiting for help, begin rapid cooling immediately. Place ice packs or bags of ice from a nearby shop under the armpits, on the groin, and on the neck. Wrap the person in a cool wet sheet. These are the areas where large blood vessels run close to the skin and cooling them brings down core temperature fastest. According to clinical guidelines, the goal is to bring body temperature below 39°C as quickly as possible before organ damage sets in.
Do not give the person anything to drink if they are confused or unconscious. Aspiration is a real risk.
If the person loses consciousness, place them in the recovery position (on their side) to keep the airway clear and stay with them until help arrives.
For families in Karachi, Lahore, or other cities with long loadshedding hours, keeping a small bag of ice in a cooler during the hottest months is a practical precaution worth taking. It takes minutes to set up and can be the difference between a safe outcome and a tragedy.
Persistent confusion, seizures, or unconsciousness after cooling are signs of serious organ stress. An emergency physician or general physician in Pakistan can advise on next steps once the patient is stable, but the first priority is always the nearest emergency room.
Prevention: Practical Steps for Pakistani Summers
Most cases of heat exhaustion and heatstroke are preventable. The measures are simple but need to be followed consistently during May to August.
- Drink water before you feel thirsty. Thirst means you are already mildly dehydrated.
- Avoid going outdoors between 11 am and 4 pm, when temperatures peak.
- Wear loose, light-coloured cotton shalwar kameez. Dark synthetic fabric traps heat.
- If you work outdoors in Lahore or Karachi, take a 10-minute shade break every hour.
- Keep ORS sachets at home and in your bag during summer.
- Check on elderly relatives and young children during loadshedding hours.
- If you are fasting in Ramadan during a heatwave, drink at least 8 to 10 glasses of water between Iftar and Sehri, and limit physical exertion in the early afternoon hours before Iftar.
For guidance on staying physically active while avoiding heat illness, the Summer Fitness in Pakistan guide has practical workout timing and hydration advice.
Get Expert Advice from Marham
Someone who has recovered from heat exhaustion or heatstroke may feel weak and unwell for a day or two. If symptoms linger beyond 48 hours, if there is persistent headache, confusion, or reduced urine output, or if the person has an underlying condition like diabetes or hypertension, a medical review is worth seeking.
A short online consultation with a general physician on Marham takes 15 to 20 minutes and can clarify whether further tests are needed or whether the recovery is on track. Marham connects patients across Pakistan, including in cities with limited specialist access, to verified doctors who consult online and can guide post-heat-illness care without requiring a hospital visit for every follow-up.
Frequently Asked Questions
Can heat exhaustion turn into heatstroke?
Yes, it can. Heat exhaustion can progress to heatstroke if the person is not cooled down quickly. If symptoms do not improve within 30 minutes of cooling and rest, treat the situation as a potential heatstroke and seek emergency care.
What is the single biggest difference between heat exhaustion and heatstroke?
Mental state is the clearest difference. A person with heat exhaustion remains alert and can speak normally. A person with heatstroke may be confused, aggressive, slurring their words, or unconscious. Any change in mental behaviour is a sign to call for emergency help immediately.
Can heatstroke happen without dry skin?
Yes. Classic heatstroke, common in elderly people during passive heat exposure, often presents with hot, dry skin. But exertional heatstroke, which affects outdoor workers and athletes, can occur with moist skin. Never rely on skin dryness alone to rule out heatstroke.
Is heatstroke more dangerous during Ramadan?
The risk is higher for anyone fasting in extreme summer heat because restricted fluid intake during the day means the body starts the afternoon already mildly dehydrated. People who fast and work outdoors should drink generously between Iftar and Sehri and avoid peak-sun outdoor activity in the hours before Iftar.
Who should see a doctor after recovering from heat exhaustion?
Anyone with an underlying condition such as diabetes, hypertension, or heart disease should get a medical review after a heat exhaustion episode. You should also consult a doctor if symptoms like weakness, headache, or reduced urine output persist beyond 48 hours. Read more about heatstroke symptoms and treatment in Pakistan for a detailed guide.
Conclusion
Heat exhaustion and heatstroke are not the same thing, and the difference matters. A clear mental state means there is still time to cool the person down at home. Confusion, aggression, or unconsciousness means it is an emergency. In Pakistan’s summers, where temperatures regularly exceed 44°C and loadshedding limits access to cooling, knowing this distinction and acting on it fast is the most practical health skill a family can have.
