Cold intolerance
Usually developing gradually, this increased sensitivity to cold temperatures reflects damage to the body’s temperature-regulating mechanism, based on interactions between the hypothalamus and the thyroid gland. Typically, the symptom results from a tumor or a hormonal deficiency. In elderly patients, cold intolerance reflects normal age-related physiologic changes.
History and physical examination
Find out when the patient first noticed cold intolerance by asking when he began using more blankets or wearing heavier clothing. A person may suffer transitory cold intolerance when moving from a tropical to a temperate climate; ask if the patient has recently made such a move. Ask about associated signs and symptoms, such as changes in vision or in the texture or amount of body hair. If the patient is female, ask about changes in her normal menstrual pattern.
Before proceeding with the physical examination, obtain a brief history. Does the patient have a history of hypothyroidism or hypothalamic disease? Is he taking any medications? If so, is he complying with the prescribed schedule and dosage? Has the regimen been changed recently?
Begin the physical examination by taking the patient’s vital signs and checking for hypothermia, dry skin, and hair loss. Then ask the patient to straighten and extend his arms. Are his hands shaking? During the examination, note if the patient shivers or complains of chills. Provide a blanket if necessary.
Medical causes
Hypopituitarism
Signs and symptoms of hypopituitarism usually develop slowly and vary with the disorder’s severity. Cold intolerance and shivering typically accompany cold, dry, thin skin with a waxy pallor and fine wrinkles around the mouth. Other findings include fatigue, lethargy, menstrual disturbances, impotence, decreased libido, nervousness, irritability, headache, and hunger. If hypopituitarism results from a pituitary tumor, expect neurologic signs and symptoms, such as headache, bilateral temporal hemianopsia, loss of visual acuity, and possibly blindness.
Hypothalamic lesion
A patient with hypothalamic damage may alternate from cold intolerance to heat intolerance. Cold intolerance develops suddenly; the patient typically complains of feeling chilled, shivering, and wearing extra clothes to keep warm. Related findings include amenorrhea, disturbed sleep pattern, increased thirst and urination, vigorous appetite with weight gain, impaired vision, headache, and personality changes, such as attacks of rage, laughing, and crying.
Hypothyroidism
Cold intolerance develops early and worsens progressively in patients with this disorder. Other early findings include fatigue, anorexia with weight gain, constipation, and menorrhagia. As hypothyroidism progresses, the patient experiences loss of libido and slowed intellectual and motor activity. His hair becomes dry and sparse; nails, thick and brittle; and skin, dry, pale, cool, and doughy. Eventually, the patient displays a dull expression with periorbital and facial edema and puffy hands and feet. Relaxation is delayed after deep tendon reflex testing. Bradycardia, abdominal distention, and ataxia may also occur.
Special considerations
Help increase the patient’s comfort by regulating his room temperature and providing extra clothing and blankets. Prepare him for diagnostic tests to determine the cause of cold intolerance.
Pediatric pointers
Some degree of cold intolerance is normal in infants because fat distribution is decreased and the temperature-regulating mechanism is immature at birth. Make sure parents understand that their infant will quickly lose body heat if he’s exposed to cold temperatures. Instruct them to dress the infant warmly before sleep and going outdoors and to avoid chilling him during his bath.
An infant with cold intolerance due to hypothyroidism may have subtle, nonspecific signs of the underlying disorder or none at all. Typically, the infant shivers and has a temperature below 86° F (30° C), blue lips, and cold, mottled skin, especially on the extremities.
Geriatric pointers
Cold intolerance is common in older people because of metabolic changes associated with aging.
Patient counseling
Allow the patient to openly express his concerns about body image changes related to his cold intolerance. Instruct him and his family to adapt the patient’s environment to meet his needs. After the cause of cold intolerance is known, explain the disease process to the patient and his family to help alleviate their anxiety. Also explain that, with proper treatment, he can expect relief from his symptoms.
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Chills
Read excerpts from these other book chapters related to Chills:
Medical Books Excerpts
- CHILLS
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- CHILLS
- "Differential Diagnosis in Primary Care" (2007)
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- Common cold
- "Professional Guide to Diseases (Eighth Edition)" (2005)
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- Skin, clammy
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Skin, clammy
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Chills
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- CHILLS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Chills
» Next page: Cold injuries (Handbook of Diseases)
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