Hypothermia

Hypothermia is reduced body temperature that happens when a body dissipates more heat than it absorbs. In humans, it is defined as a body core temperature below 35.0 °C (95.0 °F). Symptoms depend on the temperature. In mild hypothermia there is shivering and mental confusion. In moderate hypothermia shivering stops and confusion increases. In severe hypothermia, there may be paradoxical undressing, in which a person removes their clothing, as well as an increased risk of the heart stopping.

Hypothermia has two main types of causes. It classically occurs from exposure to extreme cold. It may also occur from any condition that decreases heat production or increases heat loss. Commonly this includes alcohol intoxication but may also include low blood sugar, anorexia, and advanced age. Body temperature is usually maintained near a constant level of 36.5–37.5 °C (97.7–99.5 °F) through thermoregulation. Efforts to increase body temperature involve shivering, increased voluntary activity, and putting on warmer clothing. Hypothermia may be diagnosed based on either a person’s symptoms in the presence of risk factors or by measuring a person’s core temperature.

The treatment of mild hypothermia involves warm drinks, warm clothing, and physical activity. In those with moderate hypothermia, heating blankets and warmed intravenous fluids are recommended. People with moderate or severe hypothermia should be moved gently. In those without a pulse, cardiopulmonary resuscitation (CPR) is indicated along with the above measures. Rewarming is typically continued until a person’s temperature is greater than 32 °C (90 °F).

Signs and symptoms

Signs and symptoms vary depending on the degree of hypothermia, and may be divided by the three stages of severity. Infants with hypothermia may feel cold when touched, with bright red skin and an unusual lack of energy.

Mild

Symptoms of mild hypothermia may be vague, with sympathetic nervous system excitation (shivering, high blood pressure, fast heart rate, fast respiratory rate, and contraction of blood vessels). These are all physiological responses to preserve heat. Increased urine production due to cold, mental confusion, and liver dysfunction may also be present. Hyperglycemia may be present, as glucose consumption by cells and insulin secretion both decrease, and tissue sensitivity to insulin may be blunted. Sympathetic activation also releases glucose from the liver. In many cases, however, especially in people with alcoholic intoxication, hypoglycemia appears to be a more common cause. Hypoglycemia is also found in many people with hypothermia, as hypothermia may be a result of hypoglycemia.

Moderate

As hypothermia progresses, symptoms include: mental status changes such as amnesia, confusion, slurred speech, decreased reflexes, and loss of fine motor skills.

Severe

As the temperature decreases, further physiological systems falter and heart rate, respiratory rate, and blood pressure all decrease. This results in an expected heart rate in the 30s at a temperature of 28 °C (82 °F).

There is often no shivering, cold, inflamed skin, hallucinations, lack of reflexes, fixed dilated pupils, low blood pressure, and pulmonary edema. Pulse and respiration rates decrease significantly, but fast heart rates (ventricular tachycardia, atrial fibrillation) can also occur. Atrial fibrillation is not typically a concern in and of itself.

Paradoxical undressing

Twenty to fifty percent of hypothermia deaths are associated with paradoxical undressing. This typically occurs during moderate and severe hypothermia, as the person becomes disoriented, confused, and combative. They may begin discarding their clothing, which, in turn, increases the rate of heat loss.

Rescuers who are trained in mountain survival techniques are taught to expect this; however, people who die from hypothermia in urban environments are sometimes incorrectly assumed to have been subjected to sexual assault.

One explanation for the effect is a cold-induced malfunction of the hypothalamus, the part of the brain that regulates body temperature. Another explanation is that the muscles contracting peripheral blood vessels become exhausted (known as a loss of vasomotor tone) and relax, leading to a sudden surge of blood (and heat) to the extremities, causing the person to feel overheated.

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