Dancing for long periods of time, especially in hot environments, can lead to dehydration and heatstroke. Heatstroke is a life-threatening condition. Deaths from heatstroke have occurred at raves, nightclubs, and festivals even when no drugs had been consumed.

While heatstroke can happen from overheating in general, some drugs increase the risk of heatstroke by:

1. Masking the symptoms. When you’re altered it’s not always easy to keep track of your body, especially when it comes to determining normal and abnormal drug side effects
2. Affecting the body pharmacologically. Stimulants, for example, directly increase body temperature, an effect that is compounded when you mix multiple of them together.

Heatstroke on its own is dangerous, but overheating on certain drugs can have unexpected risks:

• Many drugs become more directly toxic when your body temperature is too high. MDMA and other amphetamines are a great example of this.
• Heatstroke causes tachycardia. This can be particularly dangerous in conjunction with stimulants that raise heart rate and blood pressure.
• Certain substances may increase the seizure risk associated with heatstroke. Seizures can happen (sober or not) from being generally overstimulated or overwhelmed, and drugs that lower the seizure threshold, like antipsychotics and tramadol, increase this risk.

While heatstroke is a serious condition, taking simple precautions goes a long way in reducing the likelihood of experiencing heat-related illness. Being able to identify and respond to heatstroke is critical for all kinds of environments, especially where dancing (or lots of physical exertion) is taking place.

How to Prevent Heatstroke

Preventing heatstroke is basically an effort to keep your body cool. The most important factor here is staying hydrated, so it’s important to be drinking water consistently. A word of caution:

1. Consuming too much water can upset the body’s electrolyte balance and lead to a life-threatening condition called hyponatremia, which means that the salt in your body is too dilute.
2. On the other hand, hypernatremia is caused when you’re dehydrated and there’s too much salt in your system.
3. Both hyponatremia (overhydration) and hypernatremia (dehydration) can be very dangerous.

A good rule of thumb is to drink a little less than 1 L of water per hour when you’re exerting yourself, even if you don’t feel thirsty. This translates to around 3-4 cups of water per hour. The CDC advises against drinking more than 1.5 L of water per hour, which can lead to hyponatremia.

Basic Tips

• Drink a bottle of water an hour (2-4 cups or about 1 L), and eat some salty snacks.
• Start drinking water a few hours before dancing (and keep drinking it afterwards).
• Try to stay in good physical shape to help your heart work less hard while you exert yourself.
• Wear loose-fitting or athletic clothes that wick away moisture.
• Protect yourself from the sun with a hat, sunglasses, sunblock, and lip balm.
• Take breaks from dancing and allow your body to cool down. (Chill out areas are perfect for this!)
• Electrolyte drinks can be helpful for replenishing salt if you’re sweating a lot, although adequate food intake usually is sufficient for this. (Be mindful of sports drinks with caffeine or loads of sugar in them.)

Note: There have been some cases of hyponatremia deaths (drinking too much water) at EDM events where the individual incorrectly believed that drinking water would reduce the unpleasant effects of a negative drug experience. Panic about being in life-threatening danger, along with the belief that drinking lots of water is the solution to overheating, may have played a role in these deaths. It’s important to remember that water is not an antidote to any psychoactive drug, and that nobody should drink more than 3-4 cups (~1-1.2 L) an hour.

Some People Are More Susceptible than Others

Some people overheat easily, which could be a genetic trait, a result of certain chronic illnesses, or a consequence of diseases someone has had in the past. Patients who have survived meningitis sometimes report that they have an increased sensitivity to heat, even years after their recovery.

If you have (had) meningitis, a chronic illness, or a predisposition to heat sensitivity, or if members of your immediate family are heat sensitive, you may be at a higher risk of heatstroke than others.

The Symptoms

• Failure to sweat
• Cramps in the legs, arms, and back
• Giddiness, dizziness, headache, fatigue
• Suddenly feeling really tired, irritable and confused
• Nausea or vomiting
• Fainting or loss of consciousness
• Tachycardia (rapid heart beat)