Accidental hypothermia occurs when there is an unintentional drop in the body’s core temperature below 35°C (95°F). At this temperature, many of the compensatory physiologic mechanisms that conserve heat begin to fail. Primary accidental hypothermia is a result of the direct exposure of a previously healthy individual to the cold. The mortality rate is much higher for patients who develop secondary hypothermia as a complication of a serious systemic disorder or injury.
Primary accidental hypothermia is geographically and seasonally pervasive. Although most cases occur in the winter months and in colder climates, this condition is surprisingly common in warmer regions as well. Multiple variables render individuals at the extremes of age—both the elderly and neonates—particularly vulnerable to hypothermia (Table 454-1). The elderly have diminished thermal perception and are more susceptible to immobility, malnutrition, and systemic illnesses that interfere with heat generation or conservation. Dementia, psychiatric illness, and socioeconomic factors often compound these problems by impeding adequate measures to prevent hypothermia. Neonates have high rates of heat loss because of their increased surface-to-mass ratio and their lack of effective shivering and adaptive behavioral responses. At all ages, malnutrition can contribute to heat loss because of diminished subcutaneous fat and as a result of depleted energy stores used for thermogenesis.
TABLE 454-1Risk Factors for Hypothermia ||Download (.pdf) TABLE 454-1 Risk Factors for Hypothermia
|Age extremes ||Endocrine-related |
| Elderly || Diabetes mellitus |
| Neonates || Hypoglycemia |
|Environmental exposure || Hypothyroidism |
| Occupational || Adrenal insufficiency |
| Sports-related || Hypopituitarism |
| Inadequate clothing ||Neurologic |
| Immersion || Cerebrovascular accident |
|Toxicologic and pharmacologic || Hypothalamic disorders |
| Ethanol || Parkinson’s disease |
| Phenothiazines || Spinal cord injury |
| Barbiturates ||Multisystemic |
| Anesthetics || Trauma |
| Neuromuscular blockers || Sepsis |
| Antidepressants || Shock |
|Insufficient fuel || Hepatic or renal failure |
| Malnutrition || Carcinomatosis |
| Marasmus || Burns and exfoliative dermatologic disorders |
| Kwashiorkor || Immobility or debilitation |
Individuals whose occupations or hobbies entail extensive exposure to cold weather are at increased risk for hypothermia. Military history is replete with hypothermic tragedies. Hunters, sailors, skiers, and climbers also are at great risk of exposure, whether it involves injury, changes in weather, or lack of preparedness.
Ethanol causes vasodilation (which increases heat loss), reduces thermogenesis and gluconeogenesis, and may impair judgment or lead to obtundation. Phenothiazines, barbiturates, benzodiazepines, heterocyclic antidepressants, and other medications reduce centrally mediated vasoconstriction. Many hypothermic patients are admitted to intensive care because of drug overdose. Anesthetics can block shivering responses; their effects are compounded when patients are not insulated adequately in the operating or recovery units.
Several types of endocrine dysfunction can lead to hypothermia. Hypothyroidism—particularly when extreme, as in myxedema coma—reduces the metabolic rate and impairs thermogenesis and behavioral responses. Adrenal insufficiency and hypopituitarism also increase susceptibility to hypothermia. Hypoglycemia, most commonly caused by insulin or oral hypoglycemic drugs, is associated with hypothermia, in part because of neuroglycopenic effects on hypothalamic function. Increased osmolality and metabolic derangements associated with uremia, diabetic ketoacidosis, and ...