This study investigated the roles of endotoxemia and heat-induced tissue damage in the pathology of heat stroke. In groups of eight, male Wistar rats were treated with heat exposure only (HE), or heat exposure with turpentine (TϩHE), dexamethasone (DϩHE), and turpentine and dexamethasone combined (TDϩHE). The rats remained sedated for 2 h after receiving the respective treatments, followed by heat exposure until the core temperature (T c) was 42°C for 15 min; control rats received turpentine (T), dexamethasone (D), and turpentine and dexamethasone (TD) without heat stress. Blood samples were collected before treatment (baseline I), after 2 h of passive rest (baseline II), at T c 40°C (T40), and 15 min after achieving T c 42°C (T42). No rats died in the nonheat-stressed groups. Survival rate was lowest in the TDϩHE rats (37.5%), followed by the HE (62.5%), TϩHE (75%), and DϩHE (100%) rats (P Ͻ 0.05). The duration of survival at T42°C was shortest in the TDϩHE rats (9.9 Ϯ 6.2 min) (P Ͻ 0.01), followed by the TϩHE (11.3 Ϯ 6.1 min) and the HE (12.2 Ϯ 4 min) (P Ͻ 0.05) rats. The increase in plasma IL-6 concentrations was highest in the TϩHE (352%) and HE (178%) rats (P Ͻ 0.05). DϩHE treatment suppressed the increases in plasma aspartate transaminase, alanine aminotransferase, and IL-6 and LPS concentrations during severe heat stress. Heat stroke can be triggered by endotoxemia or heat-induced tissue damage, and preexisting inflammation compromises heat tolerance, whereas blocking endotoxemia increases heat tolerance.