Materiały źródłowe

• #1 Hypothermia (Low Body Temperature): Signs, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21164-hypothermia-low-body-temperature

  Hypothermia is a medical emergency and needs immediate treatment. […] Hypothermia, or low body temperature, is a condition that occurs when your body’s temperature drops below 95 degrees Fahrenheit (35 degrees Celsius). […] Healthcare providers diagnose hypothermia by taking your temperature and checking your symptoms. Based on your symptoms and how low your body temperature is below 95 F (35 C), they’ll diagnose you with mild, moderate or severe hypothermia. […] Hypothermia treatment includes the prevention of further heat loss and the process of rewarming. […] Hypothermia is an emergency. You should get medical help right away if you or someone you know has symptoms of hypothermia. Left untreated, hypothermia can be fatal. […] If you have symptoms of hypothermia and a low body temperature, you should call 911 or go to the emergency room immediately. Hypothermia is a medical emergency and should be treated as soon as possible.

• #2 Hypothermia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545239/

  Hypothermia is defined as a drop in body temperature below 35 C. […] Presenting symptoms depend on the severity of the condition. […] Patients with mild hypothermia have a core body temperature ranging from 32 to 35 C (90-95 F). […] The core temperature for moderate hypothermia is 28 to 32 C (82-90F). […] The core body temperature is less than 28 C (82 F) for severe or profound hypothermia. […] Worsening degrees of hypothermia result in great morbidity and mortality. […] Hypothermia occurs when the body releases more heat than it absorbs or generates. […] Hypothermia may also be iatrogenic, often from drugs like general anesthetics, beta-blockers, meperidine, clonidine, neuroleptics, and alcohol. […] Hypothermia may result in cardiorespiratory arrest. […] The presenting symptoms depend on the core body temperature, which must be obtained accurately to diagnose and manage the condition effectively.

• #3 Diagnosis and Treatment of Hypothermia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2325.html?printable=afp

  Although hypothermia is most common in patients who are exposed to a cold environment, it can develop secondary to toxin exposure, metabolic derangements, infections, and dysfunction of the central nervous and endocrine systems. […] The diagnosis of environmental hypothermia is obvious in patients found outdoors in cold climates, but may be overlooked in patients found indoors. […] When considering the diagnosis, a false sense of reassurance may be given by standard clinical thermometers, which measure only as low as 34.4C (94F). It is important to use special low-reading rectal thermometers or rectal thermistor probes, when available. […] Although the pathophysiology and clinical findings of hypothermia occur along a continuum, the generally accepted definition divides the spectrum into three zones: mild, moderate, and severe.

• #4 Hypothermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/hypothermia

  Diagnosis of Hypothermia […] Core temperature measurement […] Diagnosis is by measuring core, not oral, temperature using an electronic thermometer. Rectal and esophageal probes are most accurate. […] Temperature thresholds for classifying hypothermia severity vary. The Wilderness Medical Society Clinical Practice Guidelines uses the following: Mild: 32 to 35C, Moderate: 28 to 32C, Severe: 28C.

• #5 07. Hypothermia | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/07-hypothermia/07-hypothermia

  Hypothermia is a lower than normal core body temperature, which can further be classified as mild (32-35 C), moderate (28-32 C) or severe (28 C). […] The gold standard for core body temperature is by use of an esophageal probe, though rectal and bladder probes are acceptable. […] Mild Hypothermia: Initial increase in metabolic rate and shivering. […] Moderate Hypothermia: Neurologic: Pupillary dilation, loss of shivering, severe lethargy and confusion. […] Severe Hypothermia: CV/Respiratory: Severe bradycardia, cessation of cardiac activity or life-threatening arrhythmias (VF, VT), hypotension and decreased respiratory effort. […] General Principles of Evaluation: Obtain a reliable core body temperature; rectal probe is often easiest. […] Treat hypothermia like sepsis in already hospitalized patients. Severely hypothermic patients are best managed in the ICU.

• #6 Hypothermia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23300

  Hypothermia is defined as a drop in body temperature below 35 C. […] Presenting symptoms depend on the severity of the condition. […] Patients with mild hypothermia have a core body temperature ranging from 32 to 35 C (90-95 F). The core temperature for moderate hypothermia is 28 to 32 C (82-90F). The core body temperature is less than 28 C (82 F) for severe or profound hypothermia. […] Durrer et al use a hypothermia staging scheme for rescue work to determine which patients can benefit from resuscitation. […] Hypothermia occurs when the body releases more heat than it absorbs or generates. […] The presenting symptoms depend on the core body temperature, which must be obtained accurately to diagnose and manage the condition effectively. […] The core body temperature must be obtained immediately, as it is critical in determining the appropriate management.

• #7 Hypothermia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545239/

  The core body temperature must be obtained immediately, as it is critical in determining the appropriate management. […] In mild hypothermia, the core body temperature ranges from 32 to 35 C (90-95 F). […] Patients with moderate hypothermia have a core body temperature of 28 to 32 C (82-90 F). […] Individuals with severe hypothermia have a core body temperature of less than 28 C (82 F). […] All patients with suspected hypothermia should have a complete history and physical examination to exclude local cold-induced injuries. […] Hypothermia may arise from overdosing on some medications, such as beta-blockers, clonidine, neuroleptics, meperidine, and general anesthetic agents. […] The treatment of choice for mild hypothermia is passive external rewarming at a rate of 0.5 to 2 C per hour.

• #8 Hypothermia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hypothermia/diagnosis-treatment/drc-20352688

  The diagnosis of hypothermia usually is clear based on a person’s symptoms. The conditions in which the person with hypothermia became ill or was found also often make the diagnosis clear. Blood tests can help confirm hypothermia and its severity. […] A diagnosis may not be clear, however, if the symptoms are mild. For example, hypothermia may not be considered when an older person who is indoors has symptoms of confusion, lack of coordination and speech problems.

• #9 Diagnosis and Treatment of Hypothermia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2325.html

  Although hypothermia is most common in patients who are exposed to a cold environment, it can develop secondary to toxin exposure, metabolic derangements, infections, and dysfunction of the central nervous and endocrine systems. […] The diagnosis of environmental hypothermia is obvious in patients found outdoors in cold climates, but may be overlooked in patients found indoors. […] When considering the diagnosis, a false sense of reassurance may be given by standard clinical thermometers, which measure only as low as 34.4C (94F). It is important to use special low-reading rectal thermometers or rectal thermistor probes, when available. […] Although the pathophysiology and clinical findings of hypothermia occur along a continuum, the generally accepted definition divides the spectrum into three zones: mild, moderate, and severe.

• #10 Diagnosis and Treatment of Hypothermia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2325.html

  Although hypothermia is most common in patients who are exposed to a cold environment, it can develop secondary to toxin exposure, metabolic derangements, infections, and dysfunction of the central nervous and endocrine systems. […] The diagnosis of environmental hypothermia is obvious in patients found outdoors in cold climates, but may be overlooked in patients found indoors. […] When considering the diagnosis, a false sense of reassurance may be given by standard clinical thermometers, which measure only as low as 34.4C (94F). It is important to use special low-reading rectal thermometers or rectal thermistor probes, when available. […] Although the pathophysiology and clinical findings of hypothermia occur along a continuum, the generally accepted definition divides the spectrum into three zones: mild, moderate, and severe.

• #11 Hypothermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/hypothermia

  Core temperature measurement […] Diagnosis is by measuring core, not oral, temperature using an electronic thermometer. Rectal and esophageal probes are most accurate. […] Temperature thresholds for classifying hypothermia severity vary. The Wilderness Medical Society Clinical Practice Guidelines uses the following: Mild: 32 to 35C, Moderate: 28 to 32C, Severe: 28C. […] Laboratory tests include complete blood count, glucose (including bedside measurement), electrolytes, blood urea nitrogen, creatinine, and arterial blood gases (ABGs). […] If the cause of hypothermia is unclear, testing to detect contributing factors includes measuring a serum alcohol level, thyroid stimulating hormone (TSH), free thyroxine, and cortisol, as well as screening for other exposures (ie, certain medications and substances such as toxins or illicit drugs).

• #12 Accidental hypothermia in adults: Clinical manifestations and evaluation – UpToDate

  https://www.uptodate.com/contents/accidental-hypothermia-in-adults

  The diagnosis of accidental hypothermia is made based upon a history or other evidence of environmental exposure to cold and a core temperature below 35°C (95°F). Accurate diagnosis depends on the use of a digital or low-reading glass thermometer to determine the core temperature accurately. […] In patients with severe hypothermia requiring tracheal intubation, an esophageal probe inserted into the lower third of the esophagus (approximately 24 cm below the larynx in adults) provides a close approximation of cardiac temperature. […] Hypothermia can cause characteristic electrocardiogram (ECG) changes, including prolongation of intervals and J-point elevation in addition to bradycardia, atrial fibrillation, ventricular arrhythmias (including ventricular fibrillation), and asystole. […] The diagnosis of accidental hypothermia is made based upon a history or other evidence of environmental exposure to cold and a core temperature below 35°C (95°F). Accurate diagnosis depends on the use of a digital or low-reading glass thermometer to determine the core temperature accurately.

• #13 Symptoms of Hypothermia: Stages, Causes and Treatment | Ada

  https://ada.com/conditions/hypothermia/

  Hypothermia is when the bodys core temperature drops below 35 degrees Celsius or 95 degrees Fahrenheit. […] For a correct diagnosis, the body core temperature must be measured professionally. […] In order to recognize hypothermia and diagnose it correctly, the following is required: report or evidence of prolonged exposure to cold temperatures; core temperature below 35C (95F) that is measured with a specific thermometer. […] Additionally, other tests will be conducted to rule out complications of hypothermia and to monitor the affected person. […] Most standard thermometers read only to a minimum of 34C (93F) and are therefore of no use. […] The thermometer will be inserted either: rectally, into the bladder, or into the esophagus via the mouth- most accurate method, particularly during rewarming- also method of choice in all severe hypothermia cases.

• #14 Accidental hypothermia in adults: Clinical manifestations and evaluation – UpToDate

  https://www.uptodate.com/contents/accidental-hypothermia-in-adults-clinical-manifestations-and-evaluation

  Inconsistent vital signs or mental status suggest a secondary cause […] The diagnosis of accidental hypothermia is made based upon a history or other evidence of environmental exposure to cold and a core temperature below 35°C (95°F). Accurate diagnosis depends on the use of a digital or low-reading glass thermometer to determine the core temperature accurately.

• #15 Cold to the Core: How to Spot & Treat Severe Hypothermia Fast

  https://home.hippoed.com/blog/cold-to-the-core-how-to-spot-treat-severe-hypothermia-fast?hsLang=en

  The moment you suspect hypothermia, call EMS. These patients need controlled rewarming and cardiac monitoring that urgent care simply can’t provide. […] In severe hypothermia, you might see something unique on the ECG: the Osborn wave (also known as J wave). […] It’s not just for extreme cold; consider it in elderly patients, altered mental status cases, and prolonged exposure scenarios. […] Don’t trust forehead or oral thermometers. […] Hypothermia is more common than we think, but early recognition and interaction can be the difference between life and death.

• #16 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Hypothermia-Diagnosis.aspx

  Hypothermia occurs in three phases, which include mild, moderate, and severe hypothermia. […] Defined as a core body temperature of 32-35 C, an individual with mild hypothermia will have a pale appearance. Additionally, the skin will feel cool and the extremities will be numbed. The individual with hypothermia at this stage will also appear sluggish, drowsy, shivering uncontrollably, and exhibit both rapid heart and breathing rates. […] In moderate hypothermia, the affected individual’s core temperature will drop to 28-32 C. At this point, the victim lapses into unconsciousness, and shivering will stop. […] In severe hypothermia cases, the core temperature is very low, below 28 C. By this stage, the person is unconscious and cannot be resuscitated. The heartbeat is very slow and sometimes irregular until it ultimately stops beating. The pupils also become unreactive, while the muscles are stiff and rigid. The breathing and pulse are often imperceptible in severe hypothermia cases.

• #17 07. Hypothermia | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/07-hypothermia/07-hypothermia

  Hypothermia is a lower than normal core body temperature, which can further be classified as mild (32-35 C), moderate (28-32 C) or severe (28 C). […] The gold standard for core body temperature is by use of an esophageal probe, though rectal and bladder probes are acceptable. […] Mild Hypothermia: Initial increase in metabolic rate and shivering. […] Moderate Hypothermia: Neurologic: Pupillary dilation, loss of shivering, severe lethargy and confusion. […] Severe Hypothermia: CV/Respiratory: Severe bradycardia, cessation of cardiac activity or life-threatening arrhythmias (VF, VT), hypotension and decreased respiratory effort. […] General Principles of Evaluation: Obtain a reliable core body temperature; rectal probe is often easiest. […] Treat hypothermia like sepsis in already hospitalized patients. Severely hypothermic patients are best managed in the ICU.

• #18 Hypothermia Clinical Presentation: History, Physical Examination, Complications

  https://emedicine.medscape.com/article/770542-clinical

  Hypothermia is usually readily apparent in the setting of severe environmental exposure. […] The key to establishing a diagnosis of hypothermia is rapid determination of true core temperature. […] Obtaining a core temperature may help prevent erroneous diagnosis for patients with an altered mental status due to stroke, drug overdose, alcohol intoxication, or mental illness. […] Standard temperature measuring devices commonly used for triage may lack the capability to report unusually low temperature; obtain a core temperature reading for any patient suspected of being significantly hypothermic. […] At a given temperature, specific physical examination findings vary among patients. However, an examination does provide a frame of reference for dividing presenting symptoms into mild, moderate, and severe hypothermic signs.

• #19 Hypothermia – EMCrit Project

  https://emcrit.org/ibcc/hypothermia/

  Hypothermia is defined as 35C (95F). […] Hypothermia should be treated with respect (it’s generally more ominous than fever). […] The table above summarizes the clinical effects of different levels of hypothermia. This isn’t 100% accurate, but may provide a general idea of whether the patient’s condition can be explained by the degree of hypothermia, or whether something else is going on. For example, mild hypothermia cannot explain a coma. […] Hypothermia commonly occurs due to sepsis (particularly if no other cause is evident). […] If infection is suspected, consider starting empiric antibiotics. A reasonable approach is often to start a single broad-spectrum agent (e.g. piperacillin-tazobactam). This should be stopped within 48 hours unless there is further evidence to support infection (e.g. positive procalcitonin or positive blood culture results).

• #20 Hypothermia Clinical Presentation: History, Physical Examination, Complications

  https://emedicine.medscape.com/article/770542-clinical

  Cardiac arrhythmias at temperatures below 30-32C. […] Most patients with temperatures of 32C or lower present in stupor. […] At 30C, patients develop a higher risk for arrhythmias. […] At 28C, the body becomes markedly susceptible to ventricular fibrillation and further depression of myocardial contractility. […] Below 27C, 83% of patients are comatose.

• #21 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Hypothermia-Diagnosis.aspx

  Hypothermia occurs in three phases, which include mild, moderate, and severe hypothermia. […] Defined as a core body temperature of 32-35 C, an individual with mild hypothermia will have a pale appearance. Additionally, the skin will feel cool and the extremities will be numbed. The individual with hypothermia at this stage will also appear sluggish, drowsy, shivering uncontrollably, and exhibit both rapid heart and breathing rates. […] In moderate hypothermia, the affected individual’s core temperature will drop to 28-32 C. At this point, the victim lapses into unconsciousness, and shivering will stop. […] In severe hypothermia cases, the core temperature is very low, below 28 C. By this stage, the person is unconscious and cannot be resuscitated. The heartbeat is very slow and sometimes irregular until it ultimately stops beating. The pupils also become unreactive, while the muscles are stiff and rigid. The breathing and pulse are often imperceptible in severe hypothermia cases.

• #22 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Hypothermia-Diagnosis.aspx

  Hypothermia occurs in three phases, which include mild, moderate, and severe hypothermia. […] Defined as a core body temperature of 32-35 C, an individual with mild hypothermia will have a pale appearance. Additionally, the skin will feel cool and the extremities will be numbed. The individual with hypothermia at this stage will also appear sluggish, drowsy, shivering uncontrollably, and exhibit both rapid heart and breathing rates. […] In moderate hypothermia, the affected individual’s core temperature will drop to 28-32 C. At this point, the victim lapses into unconsciousness, and shivering will stop. […] In severe hypothermia cases, the core temperature is very low, below 28 C. By this stage, the person is unconscious and cannot be resuscitated. The heartbeat is very slow and sometimes irregular until it ultimately stops beating. The pupils also become unreactive, while the muscles are stiff and rigid. The breathing and pulse are often imperceptible in severe hypothermia cases.

• #23 Diagnostics and Therapeutics: Hypothermia — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/hypothermia

• #24 07. Hypothermia | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/07-hypothermia/07-hypothermia

  Cold hearts are irritable hearts; watch out for asystole, ventricular fibrillation and ventricular tachycardia. Risk for arrhythmia is especially high during rewarming. […] Rapid core rewarming is the key. Peripheral warming causes vasodilation and hypotension. […] Cold hearts have a poor response to cardioactive stimuli, especially those methods used in ACLS. In general, cardiac drugs and defibrillation are withheld until rewarming until at least 28 is achieved. […] ACLS meds can be pro-arrhythmic at low temperatures.

• #25 Diagnosis and Treatment of Hypothermia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2325.html?printable=afp

  The subtle symptoms of early mild to moderate hypothermia are less obvious in indoor Patients; however, indoor patients have a significantly higher mortality rate than their outdoor counterparts, most likely secondary to increased age and later time of discovery and diagnosis. […] The best strategy is to simultaneously use as many methods as are available because the body contains temperature gradients during rewarming. […] Coagulopathies typically are self-limited and require no intervention. […] The cardiovascular examination of patients with hypothermia is extremely difficult. […] The American Heart Association (AHA) recommends palpating for pulses for at least 30 to 45 seconds before initiating cardiopulmonary resuscitation. […] Although most dysrhythmias will correct with warming alone, ventricular fibrillation should be treated with defibrillation.

• #26 Diagnostics and Therapeutics: Hypothermia — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/hypothermia

  June 05, 2024

• #27 Diagnosis and Treatment of Hypothermia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2325.html

  Although hypothermia is most common in patients who are exposed to a cold environment, it can develop secondary to toxin exposure, metabolic derangements, infections, and dysfunction of the central nervous and endocrine systems. […] The diagnosis of environmental hypothermia is obvious in patients found outdoors in cold climates, but may be overlooked in patients found indoors. […] When considering the diagnosis, a false sense of reassurance may be given by standard clinical thermometers, which measure only as low as 34.4C (94F). It is important to use special low-reading rectal thermometers or rectal thermistor probes, when available. […] Although the pathophysiology and clinical findings of hypothermia occur along a continuum, the generally accepted definition divides the spectrum into three zones: mild, moderate, and severe.

• #28 Hypothermia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545239/

  Active external rewarming is necessary for moderate to severe hypothermia and mild hypothermia refractory to standard measures. […] Cardiopulmonary bypass surgery and venoarterial ECMO are the most effective but highly invasive rewarming methods. […] The differential diagnosis of hypothermia may be classified into the following: Central failure, Peripheral failure, Endocrinologic failure, Insufficient energy, Neuromuscular compromise, Dermatologic, Iatrogenic cause, Miscellaneous. […] A thorough evaluation is necessary in determining hypothermia’s underlying cause and treatment planning. […] Severe hypothermia can be lethal, though many factors may improve the prognosis. […] Individuals who are resuscitated quickly usually have good outcomes, though they may have residual frostbite and muscle injury. […] Frostbite is a complication of hypothermia that may potentially lead to limb loss if not treated in a timely fashion. […] Prompt recognition and appropriate treatment help reduce the likelihood of complications.

• #29 Diagnosis and management of periodic hypothermia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5765588/

  Hypothermia, defined as a core temperature below 35C, can occur in a variety of clinical settings, including environmental exposure, shock, infection, metabolic disorders (such as hypothyroidism, adrenal insufficiency, and Wernicke encephalopathy), malnutrition, and alcohol or drug toxicity. […] However, in rare cases patients experience recurrent episodes of hypothermia in the context of a stereotyped syndrome due to a hypothalamic lesion, which can be either congenital or acquired. […] Dysfunction, injury, or destruction of the preoptic area, whether congenital or acquired, can lead to the development of periodic hypothermia. […] Currently, only case reports or small case series exist describing patients with periodic hypothermia. […] Periodic hypothermia is a rare disorder that can occur in the context of 4 distinct syndromes: congenital periodic hypothermia with or without a structural lesion and acquired periodic hypothermia that is stereotyped or nonstereotyped.

• #30

  https://link.springer.com/article/10.1007/s12024-017-9916-z

  Significant hypothermia occurs when the body core temperature falls from its usual 37 C to below 35 C. The findings at autopsy can be quite subtle and there is a lack of accord on the necessary features required to make the diagnosis. […] The major problems for forensic pathologists are firstly how to accurately identify cases, and then how to make a credible diagnosis. […] Hypothermia is also related to a wide variety of disparate organic conditions that include diabetes mellitus, stroke, sepsis, hypothyroidism and cardiac, renal, and hepatic failure. […] In conclusion, it appears that although the phenomenon of lethal hypothermia is well recognized in forensic pathology, the diagnostic criteria and evaluation of cases remain problematic. […] The conclusion that hypothermia is the cause of death often relies not only on the quality of the death scene examination by police investigators, but also on the documentation of key features such as the ambient temperature, and the adequacy of insulation and heating for indoor deaths. […] Thus, it would appear not unreasonable to suggest that some cases of hypothermia might not be being recognized in contemporary forensic facilities.

• #31 Hypothermia – EMCrit Project

  https://emcrit.org/ibcc/hypothermia/

  Hypothermia is defined as 35C (95F). […] Hypothermia should be treated with respect (it’s generally more ominous than fever). […] The table above summarizes the clinical effects of different levels of hypothermia. This isn’t 100% accurate, but may provide a general idea of whether the patient’s condition can be explained by the degree of hypothermia, or whether something else is going on. For example, mild hypothermia cannot explain a coma. […] Hypothermia commonly occurs due to sepsis (particularly if no other cause is evident). […] If infection is suspected, consider starting empiric antibiotics. A reasonable approach is often to start a single broad-spectrum agent (e.g. piperacillin-tazobactam). This should be stopped within 48 hours unless there is further evidence to support infection (e.g. positive procalcitonin or positive blood culture results).

• #32 Accidental hypothermia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/654

  Accidental hypothermia is defined by the unintentional lowering of core body temperature to 95F (35C). […] Core temperature measured in the lower third of the esophagus correlates well with pulmonary artery temperature and is preferred in patients with a secure airway. […] Initial management should focus on stopping further cooling, resuscitation, and supportive care. […] Choice of rewarming strategy (passive external, active external, active internal/core) is based on the patients core temperature and clinical features; a combination of techniques may be used. […] Key diagnostic factors include cold exposure and body temperature 95F (35C), impaired mental status, shivering, and frostbite. […] 1st tests to order include core temperature measurement, 12-lead ECG, CBC, serum electrolytes, blood glucose, ABG, clotting screen, and chest x-ray.

• #33 Hypothermia Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/770542-workup

  Laboratory Studies […] Arterial blood gas determination includes the following: […] As a fluid is heated, gases become soluble. Therefore, the arterial blood gas (ABG) may report a falsely elevated oxygen and carbon dioxide level in patients who are hypothermic. The blood gas analyzer may also report a lower pH than a patient’s actual values. […] It is not recommended to correct the pH. The best approach is to compare uncorrected ABG values with normal values at 37C. […] Many hypothermic patients are volume contracted because of cold diuresis. As a result, hematocrit level may be deceptively high. Hematocrit levels may increase 2% for each 1C drop in core temperature. […] Hypothermia may present with wide fluctuations in electrolytes, and no clear trend or predictability exists as to when a patient’s electrolytes will be abnormal or how large swings may be. Plasma potassium levels can be useful in evaluating prognosis. A level of 10 mmol/L or greater is associated with a very low likelihood of recovery. Classic ECG changes of hyperkalemia may be absent or diminished. Chronic hypothermia occasionally can lead to hypokalemia. […] Acute hypothermia can result in hyperglycemia, while chronic hypothermia or secondary hypothermia may present with low blood glucose level. […] The body’s coagulation mechanism is often disrupted in moderate or severe hypothermia, and a disseminated intervascular coagulationtype syndrome can be present. […] Coagulopathy has several causes. The primary issue is disruption of enzymatic reactions of the clotting cascade caused by protein denaturization at decreased temperature. […] Because the kinetic tests of coagulation are performed at 37C in the laboratory, a clinically evident coagulopathy may not be reflected by deceptively normal laboratory values.

• #34 Hypothermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/hypothermia

  Core temperature measurement […] Diagnosis is by measuring core, not oral, temperature using an electronic thermometer. Rectal and esophageal probes are most accurate. […] Temperature thresholds for classifying hypothermia severity vary. The Wilderness Medical Society Clinical Practice Guidelines uses the following: Mild: 32 to 35C, Moderate: 28 to 32C, Severe: 28C. […] Laboratory tests include complete blood count, glucose (including bedside measurement), electrolytes, blood urea nitrogen, creatinine, and arterial blood gases (ABGs). […] If the cause of hypothermia is unclear, testing to detect contributing factors includes measuring a serum alcohol level, thyroid stimulating hormone (TSH), free thyroxine, and cortisol, as well as screening for other exposures (ie, certain medications and substances such as toxins or illicit drugs).

• #35 Hypothermia and frostbite – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hypothermia-and-frostbite/

  Hypothermia is defined as a drop in core body temperature below 35C (95F). […] During the diagnostic assessment, the patient’s core body temperature should be determined first, followed by an ECG. […] All patients: Measure core temperature and determine the stage of hypothermia. […] First-line: esophageal temperature probe […] Second-line: rectal or bladder thermometer […] Avoid tympanic or oral thermometers, as they do not reflect core temperature. […] Moderate or severe hypothermia […] Obtain routine diagnostics, including ECG, basic laboratory studies, ABG, and CXR. […] Consider additional diagnostics (e.g., serum toxicology, blood cultures) if LOC is inconsistent with core temperature. […] Consider alternate diagnoses (e.g., sepsis or stroke) if the clinical features are inconsistent with the body temperature (e.g., coma at a core temperature of 32C).

• #36 Hypothermia Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/770542-workup

  Laboratory Studies […] Arterial blood gas determination includes the following: […] As a fluid is heated, gases become soluble. Therefore, the arterial blood gas (ABG) may report a falsely elevated oxygen and carbon dioxide level in patients who are hypothermic. The blood gas analyzer may also report a lower pH than a patient’s actual values. […] It is not recommended to correct the pH. The best approach is to compare uncorrected ABG values with normal values at 37C. […] Many hypothermic patients are volume contracted because of cold diuresis. As a result, hematocrit level may be deceptively high. Hematocrit levels may increase 2% for each 1C drop in core temperature. […] Hypothermia may present with wide fluctuations in electrolytes, and no clear trend or predictability exists as to when a patient’s electrolytes will be abnormal or how large swings may be. Plasma potassium levels can be useful in evaluating prognosis. A level of 10 mmol/L or greater is associated with a very low likelihood of recovery. Classic ECG changes of hyperkalemia may be absent or diminished. Chronic hypothermia occasionally can lead to hypokalemia. […] Acute hypothermia can result in hyperglycemia, while chronic hypothermia or secondary hypothermia may present with low blood glucose level. […] The body’s coagulation mechanism is often disrupted in moderate or severe hypothermia, and a disseminated intervascular coagulationtype syndrome can be present. […] Coagulopathy has several causes. The primary issue is disruption of enzymatic reactions of the clotting cascade caused by protein denaturization at decreased temperature. […] Because the kinetic tests of coagulation are performed at 37C in the laboratory, a clinically evident coagulopathy may not be reflected by deceptively normal laboratory values.

• #37 Hypothermia – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/cold-injury/hypothermia

  Core temperature measurement […] Diagnosis is by measuring core, not oral, temperature using an electronic thermometer. Rectal and esophageal probes are most accurate. […] Temperature thresholds for classifying hypothermia severity vary. The Wilderness Medical Society Clinical Practice Guidelines uses the following: Mild: 32 to 35C, Moderate: 28 to 32C, Severe: 28C. […] Laboratory tests include complete blood count, glucose (including bedside measurement), electrolytes, blood urea nitrogen, creatinine, and arterial blood gases (ABGs). […] If the cause of hypothermia is unclear, testing to detect contributing factors includes measuring a serum alcohol level, thyroid stimulating hormone (TSH), free thyroxine, and cortisol, as well as screening for other exposures (ie, certain medications and substances such as toxins or illicit drugs).

• #38 Hypothermia – EMCrit Project

  https://emcrit.org/ibcc/hypothermia/

  Hypothermia may cause rhabdomyolysis. […] Hypothermia causes a clinical tendency to bleed despite normal levels of clotting factors. […] The only way to reverse this coagulopathy is re-warming. For active hemorrhage in the hypothermic patient, desmopressin might improve platelet function. […] Treating this empirically is extremely reasonable for hypothermic, shocky patients. […] Start dexamethasone (4-6 mg of IV) while awaiting the serum cortisol level. Dexamethasone is used because it doesn’t interfere with the cortisol test.

• #39

  https://step2.medbullets.com/evidence/15617296

  Although hypothermia is most common in patients who are exposed to a cold environment, it can develop secondary to toxin exposure, metabolic derangements, infections, and dysfunction of the central nervous and endocrine systems. The clinical presentation of hypothermia includes a spectrum of symptoms and is grouped into the following three categories: mild, moderate, and severe. Management depends on the degree of hypothermia present. Treatment modalities range from noninvasive, passive external warming techniques (e.g., removal of cold, wet clothing; movement to a warm environment) to active external rewarming (e.g., insulation with warm blankets) to active core rewarming (e.g., warmed intravenous fluid infusions, heated humidified oxygen, body cavity lavage, and extracorporeal blood warming). Mild to moderate hypothermia is treated easily with supportive care in most clinical settings and has good patient outcomes. The treatment of severe hypothermia is more complex, and outcomes depend heavily on clinical resources. Prevention and recognition of atypical presentations are essential to reducing the rates of morbidity and mortality associated with this condition.

• #40 Accidental hypothermia in adults: Clinical manifestations and evaluation – UpToDate

  https://www.uptodate.com/contents/accidental-hypothermia-in-adults

  The diagnosis of accidental hypothermia is made based upon a history or other evidence of environmental exposure to cold and a core temperature below 35°C (95°F). Accurate diagnosis depends on the use of a digital or low-reading glass thermometer to determine the core temperature accurately. […] In patients with severe hypothermia requiring tracheal intubation, an esophageal probe inserted into the lower third of the esophagus (approximately 24 cm below the larynx in adults) provides a close approximation of cardiac temperature. […] Hypothermia can cause characteristic electrocardiogram (ECG) changes, including prolongation of intervals and J-point elevation in addition to bradycardia, atrial fibrillation, ventricular arrhythmias (including ventricular fibrillation), and asystole. […] The diagnosis of accidental hypothermia is made based upon a history or other evidence of environmental exposure to cold and a core temperature below 35°C (95°F). Accurate diagnosis depends on the use of a digital or low-reading glass thermometer to determine the core temperature accurately.

• #41 Hypothermia ECG changes • LITFL • ECG Library Diagnosis

  https://litfl.com/hypothermia-ecg-library/

  Bradycardia is a common finding in hypothermia. Patients may manifest a variety of bradyarrhythmias: […] The height of the Osborn wave is roughly proportional to the degree of hypothermia. […] Shivering artefact is seen as a fuzziness of the ECG baseline. […] It is not specific to hypothermia and may be seen with other conditions associated with tremor (e.g. Parkinsons disease). […] Shivering artefact in a patient with hypothermia (note also the Osborn waves, bradycardia, prolonged QT).

• #42 Diagnosis – RCEMLearning

  https://www.rcemlearning.co.uk/modules/hypothermia-and-frostbite/lessons/assessment-of-hypothermia-in-the-ed/topic/diagnosis/

  All that is needed to make a diagnosis of hypothermia is a low temperature recorded on an accurate thermometer. […] The diagnosis can be easily missed by not obtaining a full set of vital signs on the patient, or by being misled by an inaccurate tympanic or oral thermometer. If hypothermia is suspected, a core temperature should be performed to confirm the diagnosis. […] The diagnosis of hypothermia may also be suspected by Osborn J waves on ECG. The upward deflection of the terminal S wave (at the junction of the QRS and the ST segment) occurs at or near 32C. It is first seen in leads II and V6.

• #43 Osborn Wave (J Wave) • LITFL • ECG Library Basics

  https://litfl.com/osborn-wave-j-wave-ecg-library/

  The Osborn wave (J wave) is a positive deflection seen at the J point in precordial and true limb leads. It is most commonly associated with hypothermia. […] Characteristically seen in hypothermia (typically T 30C), but they are not pathognomic. […] Compared to other hypothermia-induced ECG abnormalities (e.g. sinus bradycardia; supraventricular arrhythmias, QT prolongation and AV block), the Osborn wave is thought to be the most specific. […] The height of the J wave is roughly proportional to the degree of hypothermia. […] Marked J waves in severe hypothermia [Temp: 26C (78.8F)]. […] Osborn considered acidaemia induced by hypothermia as a primary cause of the Osborn wave, because it disappeared if the arterial pH was normalized by hyperventilation during the same degree of cooling. […] Over the years it has been increasingly common for clinicians to label the J-wave deflection seen in hypothermia as an Osborn wave.

• #44 Diagnostics and Therapeutics: Hypothermia — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/hypothermia

• #45 Diagnostics and Therapeutics: Hypothermia — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/hypothermia

• #46 Hypothermia Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/770542-workup

  Imaging Studies […] A chest radiograph is indicated in patients with hypoxia. Aspiration pneumonia and pulmonary edema are common findings. […] Patients with trauma or altered mental status of indeterminate cause may need a noncontrast head CT scan and further imaging for a standard trauma evaluation. […] Other Tests […] The ECG may show prolonged PR, QRS, and QT intervals, and atrial or ventricular arrhythmias. The length and height of the respective QT-interval prolongation and characteristic J (Osborne) waves are often proportional to the degree of hypothermia.

• #47 Diagnosis and management of periodic hypothermia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5765588/

  A thorough clinical history and ancillary testing are essential to make the diagnosis. […] Testing should include an MRI of the brain with contrast to evaluate for agenesis of the corpus callosum, a tumor in the hypothalamic region, or other structural abnormalities. […] The medications reported to have efficacy as prophylaxis against future episodes include clonidine, clomipramine, and cyproheptadine. […] The episodes, by definition, resolve spontaneously without a lasting neurologic deficit. […] Recognition of a specific periodic hypothermia syndrome can inform treatment decisions, with successful treatment ending the episodes and improving the patient’s quality of life.

• #48 Diagnostics and Therapeutics: Hypothermia — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/hypothermia

  June 05, 2024

• #49

  https://journals.lww.com/jfsm/fulltext/2024/10040/diagnosis_of_the_death_from_hypothermia_on.4.aspx

  Diagnosis of fatal hypothermia is challenging by autopsy approach alone. […] To explore the features of fatal hypothermia on postmortem computed tomography (PMCT) and study their diagnostic value in such cases. […] The typical postmortem imaging manifestations of death from hypothermia include increased volume of bilateral lung tissue, decreased density of bilateral lung tissue, and absence of pulmonary hypostasis. […] By comparison, it has been proven that PMCT can quickly detect typical changes in postmortem imaging of death from hypothermia. […] After applying PMCT, combined with the results of postmortem imaging, physical and chemical, and the environmental condition of the scene, in the absence of individual deaths because of other reasons, it can be determined that the individual died from hypothermia.

• #50 Deep Learning-Based Diagnosis of Fatal Hypothermia Using Post-Mortem Computed Tomography

  https://www.jstage.jst.go.jp/article/tjem/260/3/260_2023.J041/_html/-char/ja

  In forensic medicine, fatal hypothermia diagnosis is not always easy because findings are not specific, especially if traumatized. […] Post-mortem computed tomography (PMCT) is a useful adjunct to the cause-of-death diagnosis and some qualitative image character analysis, such as diffuse hyperaeration with decreased vascularity or pulmonary emphysema, have also been utilized for fatal hypothermia. […] The diagnosis of hypothermia relies on a combination of autopsy findings related to hypothermia and the exclusion of other possible causes of death. […] Therefore, post-mortem computed tomography (PMCT) was introduced to assist in the diagnosis of hypothermia, which could provide a non-invasive and comprehensive evaluation of the body’s internal structures and abnormality information. […] To overcome the challenges above, we proposed the first deep learning-based diagnosis system for hypothermia, and further explored the possibility of utilizing the models for direct confirmation after the on-site investigation, instead of just helping with diagnosis. […] In this paper, we trained deep convolutional neural networks (DCNNs) to diagnose fatal hypothermia using PMCT images and evaluated them on an independent test set. […] We proposed a deep learning-based computer-aided diagnosis system for hypothermia using post-mortem lung CT images.

• #51 Hypothermia (Low Body Temperature): Signs, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21164-hypothermia-low-body-temperature

  Hypothermia is a medical emergency and needs immediate treatment. […] Hypothermia, or low body temperature, is a condition that occurs when your body’s temperature drops below 95 degrees Fahrenheit (35 degrees Celsius). […] Healthcare providers diagnose hypothermia by taking your temperature and checking your symptoms. Based on your symptoms and how low your body temperature is below 95 F (35 C), they’ll diagnose you with mild, moderate or severe hypothermia. […] Hypothermia treatment includes the prevention of further heat loss and the process of rewarming. […] Hypothermia is an emergency. You should get medical help right away if you or someone you know has symptoms of hypothermia. Left untreated, hypothermia can be fatal. […] If you have symptoms of hypothermia and a low body temperature, you should call 911 or go to the emergency room immediately. Hypothermia is a medical emergency and should be treated as soon as possible.

• #52 Accidental hypothermia in adults: Clinical manifestations and evaluation – UpToDate

  https://www.uptodate.com/contents/accidental-hypothermia-in-adults-clinical-manifestations-and-evaluation

  Accidental hypothermia in adults: Clinical manifestations and evaluation […] The definition, pathophysiology, and evaluation of accidental hypothermia will be discussed here. […] Hypothermia is defined as a core temperature below 35°C (95°F). The stage of hypothermia, defined by core temperature, has a large impact on both recognition and treatment. […] The diagnosis of accidental hypothermia is made based upon a history or other evidence of environmental exposure to cold and a core temperature below 35°C (95°F). Accurate diagnosis depends on the use of a digital or low-reading glass thermometer to determine the core temperature accurately. […] In moderate or severe hypothermia, the heart can be very sensitive to movement. […] Clinical findings associated with the progressive stages of hypothermia are described above.

• #53 Diagnostics and Therapeutics: Hypothermia — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/hypothermia

  June 05, 2024

• #54 Hypothermia

  https://www.visualdx.com/visualdx/diagnosis/?diagnosisId=54618&sex=-1&moduleId=102

  Hypothermia in children is defined by a core body temperature below 35°C (95°F). It is considered a medical emergency and is usually accidental in children. […] The key to management is timely diagnosis and initial support of the patient’s airway, breathing, and circulation (ABC). Patients should be removed from the hypothermic environment, and rewarming should be initiated as soon as possible. […] Laboratory derangements such as hyper- or hypoglycemia, thrombocytopenia, leukopenia, elevated creatine phosphokinase (CPK) secondary to rhabdomyolysis, and abnormal liver function tests may also be present in patients with moderate or severe hypothermia.

• #55 Diagnostics and Therapeutics: Hypothermia — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/hypothermia

  June 05, 2024

• #56 Diagnostics and Therapeutics: Hypothermia — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/hypothermia

• #57 Hypothermia | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/healthyliving/hypothermia

  Hypothermia occurs when the bodys temperature falls below 35 C. […] Severe hypothermia is life-threatening without prompt medical attention. […] If core body temperature is lower than 28C, the condition is life-threatening without immediate medical attention. […] First aid steps for severe hypothermia include: In an emergency, call triple zero (000). […] Never assume a person is dead. A person with severe hypothermia may only take one breath per minute, with a heart rate of less than 20 beats per minute. Always assume they are alive. […] The first step in all cases of hypothermia is to prevent any further heat loss. […] If the person is moderately or severely hypothermic, move them as gently as possible. […] CPR can be lifesaving for a person with severe hypothermia who may appear to be dead.

• #58 Diagnosis and Treatment of Hypothermia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2325.html?printable=afp

  The decision to use passive or active rewarming techniques should be based on several clinical parameters and the degree of hypothermia. […] Active core rewarming techniques exist on a spectrum of invasiveness and potential complications. […] The most effective method of active core rewarming is extracorporeal blood warming, accomplished by cardiopulmonary bypass, arteriovenous rewarming, venovenous rewarming, or hemodialysis. […] Resuscitation should not be discontinued, even in a patient who appears to be dead, until the core body temperature is greater than 30C to 32C (89.6F) and still no signs of life are apparent.

• #59 Diagnostics and Therapeutics: Hypothermia — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/hypothermia

• #60 Diagnostics and Therapeutics: Hypothermia — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/hypothermia

• #61 Hypothermia

  https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Hypothermia

  To guide Emergency Department (ED) staff with the assessment and management of hypothermia. […] Check core temperature using a rectal or oesophageal thermometer. […] Monitor core temperature […] Monitor heart rate and rhythm […] Check electrolytes and glucose. […] Hypothermia substantially reduces effectiveness of defibrillation and resuscitation drugs. It is reasonable to attempt defibrillation, but if unsuccessful, continue cardiac compression until core temperature is 30C, when defibrillation / drugs are more likely to be effective. […] Never diagnose death and thus stop resuscitation until the patient is rewarmed to at least 32C or cannot be rewarmed despite active measures. […] Aim to warm no faster than 1-2 C per hour (NB: Rapid rewarming may cause vasodilation and consequently hypotension.) […] Monitor the patients temperature 15-30 minutely via axilla / tympanic thermometer or continuously with the reusable or single use Phillips oesophageal temperature probe. […] Patients must be kept dry as warming will be less effective if patient is damp.

• #62 An Intriguing Diagnosis

  https://www.patientcareonline.com/view/intriguing-diagnosis

  A 62-year-old woman was found on the floor of her bathroom at home with her wheelchair partially on top of her. […] When she arrives at the emergency department (ED), the patient is still unresponsive; her temperature is 29C (84.2F). […] Hypothermia occurs in all geographic locations and during all seasons. It is defined as a core temperature of less than 35C (95F). […] Approximately 700 deaths occur annually from hypothermia in the United States; half of these are associated with extremely cold weather. […] Signs of severe hypothermia include apnea; extreme bradycardia; coma; hypotension; impalpable pulses; and fixed, dilated pupils. […] Hypothermia may be precipitated in a healthy person by acute exposure to a cold environment, more prolonged exposure in a less cold environment (chronic hypothermia), or forced inactivity (eg, after a fall).

• #63 An Intriguing Diagnosis

  https://www.patientcareonline.com/view/intriguing-diagnosis

  Disease states associated with hypothermia include stroke, CNS infection or trauma, uremia, Parkinson disease, and multiple sclerosis. […] Elderly persons are especially prone to hypothermia. The ability to thermoregulate becomes impaired with age. […] Airway, breathing, and circulation concerns need to be addressed quickly and efficiently. […] Management should also include evaluation for trauma, especially if there is a recent history of a fall or if the patient was found unconscious. […] A critical element of treatment is appropriate rewarming. […] Most patients with hypothermia are treated with a combination of passive rewarming and warm fluids. […] The cause of the hypothermia was probably a combination of prolonged immobility following a fall precipitated by her multiple sclerosis, and the underlying diabetes.

• #64 Nursing Diagnosis: Understanding Neonatal Hypothermia and Its Impact

  https://nursipedia.com/neonatal-hypothermia/

  Neonatal hypothermia is defined as a core body temperature of an infant that falls below the normal daytime range. Maintaining an appropriate body temperature is crucial for neonates as they are particularly vulnerable to temperature fluctuations due to their higher surface area-to-volume ratio and limited thermoregulation capabilities. […] The defining characteristics of neonatal hypothermia can be classified into subjective and objective signs that caregivers and healthcare professionals can observe during assessment. […] Objective characteristics are measurable and observable indicators that can be seen during clinical evaluation. […] Understanding the related factors that contribute to neonatal hypothermia is essential for preventing and addressing this condition effectively. […] Certain groups of neonates are at heightened risk for developing hypothermia, highlighting the need for targeted interventions.

• #65 Hypothermia in a Neonate

  https://pedemmorsels.com/hypothermia-in-a-neonate/

  There is some variability in the literature on this topic (naturally nothing can be easy sometimes) […] Most mention a core body temperature of below 35-35.5C (95- 95.9F) as the mark of hypothermia […] Others state anything below 36.5C (97.7F) is abnormal (that seems relatively high to me) […] Much of the literature on environmental exposure related hypothermia use 35C, but realize that that might not strictly apply to hypothermia due to infection. […] Because of this, it will likely be necessary to monitor for a trend and use your judgement. […] If the neonate appears truly lethargic or unwell at all, go full court press and do a full sepsis work-up and start antibiotics while considering other possible etiologies like intracranial insults. […] If, on the other hand, you dont get a history that truly fits environmental heat loss, then it is most prudent to consider infectious and metabolic etiologies.

• #66 Diagnosis and management of periodic hypothermia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5765588/

  Hypothermia, defined as a core temperature below 35C, can occur in a variety of clinical settings, including environmental exposure, shock, infection, metabolic disorders (such as hypothyroidism, adrenal insufficiency, and Wernicke encephalopathy), malnutrition, and alcohol or drug toxicity. […] However, in rare cases patients experience recurrent episodes of hypothermia in the context of a stereotyped syndrome due to a hypothalamic lesion, which can be either congenital or acquired. […] Dysfunction, injury, or destruction of the preoptic area, whether congenital or acquired, can lead to the development of periodic hypothermia. […] Currently, only case reports or small case series exist describing patients with periodic hypothermia. […] Periodic hypothermia is a rare disorder that can occur in the context of 4 distinct syndromes: congenital periodic hypothermia with or without a structural lesion and acquired periodic hypothermia that is stereotyped or nonstereotyped.

• #67 Orphanet: Spontaneous periodic hypothermia

  https://www.orpha.net/en/disease/detail/29822

  A rare neurologic disorder characterized by spontaneous periodic hypothermia and hyperhidrosis in the absence of hypothalamic lesions. […] Diagnosis includes physical and systemic examinations which show a pale, cold skin and normal blood count and electrolyte levels. Imaging studies may in some cases reveal confluent lesions in the corpus callosum and a circumscribed lesion in the right posterior thalamus. 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) levels in cerebrospinal fluid may be below the normal ranges. […] Differential diagnosis of SPH severe hypothyroidism, hypoglycemia or attacks of diabetic ketoacidosis. […] There is no cure for SPH. Management is mainly supportive and includes re-warming with a warm blanket. Carbamazepine, clonidine, cyproheptadine, glycopyrrolate, bromocriptine, chlorpromazine, beta1 blockers or sympathectomy are used with varying responses.

• #68 Diagnosis and management of periodic hypothermia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5765588/

  A thorough clinical history and ancillary testing are essential to make the diagnosis. […] Testing should include an MRI of the brain with contrast to evaluate for agenesis of the corpus callosum, a tumor in the hypothalamic region, or other structural abnormalities. […] The medications reported to have efficacy as prophylaxis against future episodes include clonidine, clomipramine, and cyproheptadine. […] The episodes, by definition, resolve spontaneously without a lasting neurologic deficit. […] Recognition of a specific periodic hypothermia syndrome can inform treatment decisions, with successful treatment ending the episodes and improving the patient’s quality of life.

• #69 Hypothermia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545239/

  Hypothermia is defined as a drop in body temperature below 35 C. […] Presenting symptoms depend on the severity of the condition. […] Patients with mild hypothermia have a core body temperature ranging from 32 to 35 C (90-95 F). […] The core temperature for moderate hypothermia is 28 to 32 C (82-90F). […] The core body temperature is less than 28 C (82 F) for severe or profound hypothermia. […] Worsening degrees of hypothermia result in great morbidity and mortality. […] Hypothermia occurs when the body releases more heat than it absorbs or generates. […] Hypothermia may also be iatrogenic, often from drugs like general anesthetics, beta-blockers, meperidine, clonidine, neuroleptics, and alcohol. […] Hypothermia may result in cardiorespiratory arrest. […] The presenting symptoms depend on the core body temperature, which must be obtained accurately to diagnose and manage the condition effectively.

• #70 Hypothermia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545239/

  The core body temperature must be obtained immediately, as it is critical in determining the appropriate management. […] In mild hypothermia, the core body temperature ranges from 32 to 35 C (90-95 F). […] Patients with moderate hypothermia have a core body temperature of 28 to 32 C (82-90 F). […] Individuals with severe hypothermia have a core body temperature of less than 28 C (82 F). […] All patients with suspected hypothermia should have a complete history and physical examination to exclude local cold-induced injuries. […] Hypothermia may arise from overdosing on some medications, such as beta-blockers, clonidine, neuroleptics, meperidine, and general anesthetic agents. […] The treatment of choice for mild hypothermia is passive external rewarming at a rate of 0.5 to 2 C per hour.

• #71 Hypothermia: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hypothermia-pro

  Hypothermia is defined as a core body temperature below 35C. Hypothermia belongs to the lethal triad (with coagulopathy and acidosis) for trauma victims requiring critical care. […] Hypothermia may be deliberate (see below) or accidental. Any patient whose core temperature drops accidentally below 36C at any stage of the perioperative pathway (from the hour before induction of anaesthesia until 24 hours after entry into the recovery area) should be warmed using a forced air warming device. […] Hypothermia with intracorporeal temperature monitoring may be used for hypoxic perinatal brain injury. […] This is directed at re-warming, careful patient monitoring and treatment of complications such as cardiac arrhythmias. […] The patient should ideally be managed in a critical care setting. Attempts to re-warm the patient actively should not delay transfer to a critical care setting.

• #72 Hypothermia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545239/

  Active external rewarming is necessary for moderate to severe hypothermia and mild hypothermia refractory to standard measures. […] Cardiopulmonary bypass surgery and venoarterial ECMO are the most effective but highly invasive rewarming methods. […] The differential diagnosis of hypothermia may be classified into the following: Central failure, Peripheral failure, Endocrinologic failure, Insufficient energy, Neuromuscular compromise, Dermatologic, Iatrogenic cause, Miscellaneous. […] A thorough evaluation is necessary in determining hypothermia’s underlying cause and treatment planning. […] Severe hypothermia can be lethal, though many factors may improve the prognosis. […] Individuals who are resuscitated quickly usually have good outcomes, though they may have residual frostbite and muscle injury. […] Frostbite is a complication of hypothermia that may potentially lead to limb loss if not treated in a timely fashion. […] Prompt recognition and appropriate treatment help reduce the likelihood of complications.

• #73 Hypothermia and frostbite – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hypothermia-and-frostbite/

  ECG findings in hypothermia […] Heart blocks and dysrhythmias: variable; depends on core temperature […] Prolongation of all ECG intervals. […] Obtain basic laboratory studies to rule out complications and guide resuscitation. […] The lethal triad of hypothermia, acidosis, and coagulopathy is associated with poor outcomes in patients with cold exposure and severe trauma. […] Frostbite is a clinical diagnosis. […] Measure core temperature in all patients to rule out hypothermia. […] Consider imaging to evaluate for injury and determine tissue viability. […] Consider additional diagnostics for patients with concurrent hypothermia or other injuries.

• #74 Hypothermia – EMCrit Project

  https://emcrit.org/ibcc/hypothermia/

  Hypothermia may cause rhabdomyolysis. […] Hypothermia causes a clinical tendency to bleed despite normal levels of clotting factors. […] The only way to reverse this coagulopathy is re-warming. For active hemorrhage in the hypothermic patient, desmopressin might improve platelet function. […] Treating this empirically is extremely reasonable for hypothermic, shocky patients. […] Start dexamethasone (4-6 mg of IV) while awaiting the serum cortisol level. Dexamethasone is used because it doesn’t interfere with the cortisol test.

• #75 Accidental hypothermia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000179

  Hypothermia is defined by a core body temperature 35C (95F). […] Classified as mild, moderate, or severe according to the patients core temperature and clinical features. […] Core temperature measured in the lower third of the oesophagus correlates well with pulmonary artery temperature and is preferred in patients with a secure airway. […] Key diagnostic factors include presence of risk factors, cold exposure and body temperature 35C (95F), cognitive impairment, shivering, and frostbite. […] 1st investigations to order include core temperature measurement, 12-lead ECG, blood glucose, blood gas, serum urea, electrolytes, and creatinine, FBC, clotting screen, and chest x-ray. […] Investigations to consider include serum creatine kinase, myoglobin levels, end-tidal CO, and ultrasound.

• #76 Hypothermia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545239/

  Hypothermia occurs when the body dissipates more heat than it absorbs or creates, resulting in failure to maintain homeostasis and proper bodily function. […] Familiarity with its myriad presentations and management strategies is crucial to medical practice. […] This activity equips clinicians to contribute meaningfully to the multidisciplinary care of patients with this condition. […] Identify possible hypothermia causes and describe the bodily changes associated with this condition. […] Describe the common presentations of a patient with accidental hypothermia. […] Determine the appropriate management approach for patients presenting with hypothermia. […] Develop effective collaboration and communication strategies within the interprofessional team to enhance outcomes for patients presenting with hypothermia.

• #77 Accidental hypothermia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/654

  Accidental hypothermia is defined by the unintentional lowering of core body temperature to 95F (35C). […] Core temperature measured in the lower third of the esophagus correlates well with pulmonary artery temperature and is preferred in patients with a secure airway. […] Initial management should focus on stopping further cooling, resuscitation, and supportive care. […] Choice of rewarming strategy (passive external, active external, active internal/core) is based on the patients core temperature and clinical features; a combination of techniques may be used. […] Key diagnostic factors include cold exposure and body temperature 95F (35C), impaired mental status, shivering, and frostbite. […] 1st tests to order include core temperature measurement, 12-lead ECG, CBC, serum electrolytes, blood glucose, ABG, clotting screen, and chest x-ray.

• #78 Hypothermia (Low Body Temperature): Signs, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21164-hypothermia-low-body-temperature

  Hypothermia is a medical emergency and needs immediate treatment. […] Hypothermia, or low body temperature, is a condition that occurs when your body’s temperature drops below 95 degrees Fahrenheit (35 degrees Celsius). […] Healthcare providers diagnose hypothermia by taking your temperature and checking your symptoms. Based on your symptoms and how low your body temperature is below 95 F (35 C), they’ll diagnose you with mild, moderate or severe hypothermia. […] Hypothermia treatment includes the prevention of further heat loss and the process of rewarming. […] Hypothermia is an emergency. You should get medical help right away if you or someone you know has symptoms of hypothermia. Left untreated, hypothermia can be fatal. […] If you have symptoms of hypothermia and a low body temperature, you should call 911 or go to the emergency room immediately. Hypothermia is a medical emergency and should be treated as soon as possible.

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