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Most of those killed by Wednesday's 7.4 magnitude quake were crushed under debris in San Marcos state, a mountainous region near the Mexican border. Nearly two dozen people were still missing and President Otto Perez forecast the death toll would climb from 52.
But in a glimmer of hope, emergency workers said they pulled seven people alive from rubble at a construction site on the outskirts of San Marcos city.
Lying in a hospital bed in obvious pain, Jesus Ramirez recounted how he had tried to rescue his nieces and was trapped.
"My mother shouted to me to go and see my nieces ... I wanted to pull them out, but couldn't because the wall of my house fell on them and on me too," he said. "I lost my leg, they amputated it."
His mother and two nieces were later found dead.
On the outskirts of the city of San Marcos, rescuers stepped up efforts at a collapsed construction site. Emergency workers in white hard hats used tractors and trucks to shift debris blocking roads. Cars were crushed, highways were peppered with gaping cracks and modest homes had crumbled.
"The people of San Marcos are in deep mourning," said Wilfred de Leon, one of whose relatives was buried by rubble and feared dead.
The quake destroyed roads and forced evacuations as far away as Mexico City. It was the strongest to hit the Central American nation since 1976, when a 7.5-magnitude quake killed more than 20,000 people.
"Sadly we expect the number (of dead) to keep rising," President Perez told a news conference in Guatemala City. He said 22 people were missing and around 200 injured. Hundreds more were living in shelters.
Help has poured in from afar afield as Taiwan, including 44 tonnes of humanitarian aid destined for San Marcos.
Perez was set to fly to Quetzaltenango, the country's second largest city, to survey nearby damage later in the day. He said nearly 3,000 people had been evacuated from their homes, while more than 1 million have been affected by the quake.
"Reconstruction will not be easy because there are homes that are uninhabitable," Perez said, adding that the government had set aside $60 million for rebuilding.
He announced a state of emergency in four of the country's 22 states - San Marcos, Quetzaltenango, Quiche, and Huehuetenango.
Local Red Cross chief Carlos Enrique Alvarado said on Wednesday that 75 homes were destroyed in the city of San Marcos alone and authorities said damage to the prison forced them to transfer 101 inmates to another jail.
Perez, who announced three days of national mourning, said he was suspending all vacation time for more than 25,000 members of the national police force, who are being enlisted in rescue and cleanup efforts.
Authorities have distributed 16,000 emergency rations and mobilized more than 2,000 soldiers to help with the rescue effort.
The quake's epicentre was 42km below the surface, according to the U.S. Geological Survey. It was felt in El Salvador and more than 1223km away in Mexico City, where some people also fled offices and homes.