Diagnosis of Hypothermia
Hypothermia Diagnosis: Book Excerpts
Tests and diagnosis discussion for Hypothermia:
To figure out whether someone is suffering from hypothermia, take
his or her temperature with a thermometer. First shake the
thermometer to below its lowest point. Then, if the temperature
appears to be below 96° F (35.5° C) or it can’t be read on an oral
thermometer, take the person’s temperature again using a rectal
thermometer for a more exact reading. If the thermometer still does
not show the temperature or is below 96 degrees F, call for
emergency help. The only way to tell accurately if a person has
hypothermia is to use a special thermometer that can read
temperatures below 94° F (34° C). Most hospitals have these
thermometers. (Source: excerpt from Accidental Hypothermia - Age Page - Health Information: NIA)
Diagnostic Tests for Hypothermia: Online Medical Books
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HYPOTHERMIA:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there a history of drug or alcohol ingestion? Alcoholic intoxication, opium poisoning, tricyclic antidepressants, and phenothiazine may cause hypothermia.
- Is there a history of severe vomiting or diarrhea? Severe vomiting or diarrhea may induce dehydration and electrolyte disturbances, which will induce hypothermia. Intestinal obstruction, cholera, and peritonitis are among the many disorders that may lead to severe vomiting or diarrhea.
- Are there endocrine abnormalities? Signs of hypothyroidism and Addison's disease may be obvious, but hypopituitarism, hypoglycemia, and diabetes mellitus may also be the cause of hypothermia.
- Are there abnormalities on the neurologic examination? Focal neurologic findings may be seen in a cerebral vascular accident or epidural or subdural hematoma. However, thiamine deficiency may also result in hypothermia.
DIAGNOSTIC WORKUP
Routine laboratory tests include a CBC and differential count, a sedimentation rate and chemistry panel, electrolytes, thyroid profile, blood cultures, urinalysis, and a urine drug screen. An EKG and chest x-ray should also be done. A CT scan of the brain is done if there are focal neurologic abnormalities or disorders of consciousness.
An infusion of dextrose intravenously and thiamine are given as soon as blood studies are drawn in case there is hypoglycemia or thiamine deficiency.
If the above studies are normal, a thorough endocrine workup is indicated, including tests for serum cortisol, FSH, lutein-stimulating hormone (LSH), and growth hormone. A cardiologist, neurologist, or endocrinologist may need to be consulted to help solve the diagnostic dilemma.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Hypothermia:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Exposure
–Alcohol intake is a common risk factor because it both alters thermoregulation and promotes risk-taking behavior
–Shivering, amnesia, ataxia, and dysarthria occur with mild hypothermia (>89.6°F, or >32°C)
–Stupor, absence of shivering, atrial fibrillation, and/or bradycardia occur with moderate hypothermia (82–90°F, or 28–32°C)
–Coma, ventricular fibrillation, apnea, asystole, and/or areflexia occur with severe hypothermia (<82.4°F, or <28°C) - Sepsis
–Mild hypothermia is common in sepsis, especially in infection with gram-negative rods (e.g., E. coli), and in the elderly
- Hypothyroidism
–Up to 10 times more common in females
–May be of autoimmune, postsurgical, or pituitary etiology
–Symptoms include hypothermia, hair loss, dry skin, pretibial myxedema, weight gain, constipation, and prolonged relaxation phase of deep tendon reflexes
-
Stroke
–Hypothermia may occur because of altered cerebral thermoregulation
-
Hypovolemic shock
–Poor peripheral perfusion often results in mild hypothermia
-
Massive blood transfusion
–Due to refrigerated blood that is rapidly transfused without warming
End-stage liver disease
–Consider spontaneous bacterial peritonitis and sepsis in patients with ascites
Workup and Diagnosis
-
A complete history and physical examination are essential, especially if there is no definite history of exposure
–Careful examination of the extremities and dependent body parts for signs of frostbite
–Assess core temperature (rectal temperature is preferred) using a low-temperature thermometer
-
ECG may reveal Osborne J waves if temperature is less than 91.4°F (33°C)
-
Laboratory studies may include CBC, electrolytes, BUN/creatinine, glucose, calcium, liver function tests, coagulation studies, blood and urine cultures, TSH, free T4, arterial blood gas analysis, creatine kinase, and urinalysis (evaluate for rhabdomyolysis)
-
Chest X-ray may be indicated to assess for infection in cases of suspected sepsis
-
Head CT scan to evaluate for altered mental status
-
Blood cultures are indicated if infection and/or sepsis are suspected
>>
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Hypothermia:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Cold exposure
–Infants and younger children are more prone to heat loss due to higher surface-to-weight ratio and poor adaptive behavioral response to cold
–Immersion and near drowning are the most frequent causes of hypothermia throughout childhood
–Hypothermia is the leading cause of death during outdoor recreation (winter sports, climbing)
-
Drugs
–Antipyretics, sedatives, anesthetics,
phenothiazines, oral hypoglycemics
–Alcohol ingestion causing vasodilation
-
Sepsis or other serious bacterial infection especially in neonates and in the immunocompromised host
-
Endocrinologic disorders
–Hypoglycemia, hypothyroidism,
hypopituitarism, hypoadrenalism
- Iatrogenic
–Surgery (during and immediately after) as a combination of anesthetics and sometimes visceral exposure to the usually cool operating environment
–Inadequate thermal support during transport and resuscitation
–Infusion of cold IV fluids and blood products
-
Malnutrition/starvation
–Children die from hypothermia in the tropics despite the high temperature
-
Eating disorders
–15% of patients with anorexia nervosa have temperature below 95°F (35°C)
-
Trauma, burns, and other dermatologic conditions that impair the body's ability to decrease heat loss
-
Neurologic and neuromuscular disorders
–Central dysfunction of thermoregulatory
control
–Immobilizing conditions
–Intracranial hemorrhage or infarction
–CNS tumors
–Congenital absence of the corpus callosum
-
Familial dysautonomia
-
Menkes syndrome (kinky-hair disease)
-
Water intoxication
Workup and Diagnosis
-
History
–Exposure to cold weather or immersion in cold water
–Severe injury and conditions when victim was found (wet or windy environment); transport/resuscitation
–Home temperature and presence of heating system
–Prolonged exposure during physical examination
–Medications, alcohol ingestion
–Immobilizing conditions
–Behaviors consistent with an eating disorder
-
Physical exam
–Low-reading thermometer (most thermometers don’t
read temperatures below 93.2°F [34°C])
–Patient may not necessarily “feel” cold
–Bradycardia, decreased or unobtainable BP
–Peripheral pulses weak (vasoconstriction)
–Cyanosis or pallor followed by flushing
–Shivering followed by muscle rigidity
–Pupils may be dilated and nonreactive
–CNS dysfunction with confusion, slurred speech,
paradoxical behavior (e.g., undressing)
-
Labs
–Serum glucose (hyper- then hypoglycemia)
–Electrolytes (shifts occur during rewarming)
–Arterial blood gas (pH rises, PaO2 and PaCO2fall)
–CBC (hematocrit increases due to hypovolemia)
–Urine drug screen, blood alcohol level
–ECG, thyroid function tests
-
Radiology: Appropriate imaging for trauma patients
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
HYPOTHERMIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Establishing a definitive diagnosis of hypothermia depends heavily on the interpretation of other symptoms and signs. A good history is invaluable as well as laboratory studies including FBS, thyroid functions, electrolytes, BUN, and drug screens; in selected cases, a spinal tap may be useful.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Hypothermia:
History
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Obtain the patient’s history for clues to the causative factor. Was he exposed to cold and if so, what temperature and for what length of time? Ask whether he has recently undergone hemodialysis therapy. Has he had major surgery, especially a type of surgery that requires cooling of the patient’s body? Has he recently received a blood transfusion that may have been administered while the blood was still cold? Does he have a history of thyroid, adrenal, liver, or cerebrovascular disease? Has the patient ingested any substances that result in a lowered body temperature, such as alcohol or barbiturates? If the exposure occurred indoors, determine whether the patient has adequate heat in his home. If the exposure occurred outdoors, determine whether he’s homeless and sleeping outside.
Physical examination
Assess level of consciousness; a patient with mild hypothermia will have amnesia, a patient with moderate hypothermia is unresponsive, and the patient with severe hypothermia will be comatose. A patient with a body temperature below 86° F (30° C) is at risk for cardiopulmonary arrest. Assess for shivering, slurred speech, and peripheral cyanosis. Assess the patient’s neurologic status and presence or absence of deep tendon reflexes. Assess for muscle rigidity that can produce a rigor-mortis-like state.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
HYPOTHERMIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Establishing a definitive diagnosis of hypothermia depends heavily on
the interpretation of other symptoms and signs. A good history is invaluable
as well as laboratory studies including fasting blood sugar (FBS), thyroid
functions, electrolytes, BUN, and drug screens; in selected cases, a spinal
tap may be useful.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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