Hypothermia

Hypothermia is defined as a core body temperature below 95°F (35°C). Distinction is made between primary hypothermia, which is due to accidental cold exposure, and secondary, in which a specific disease is the cause. A distinction is also made among mild (89.6–95°F [32–35°C]), moderate (82.4–89.6°F [28–32°C]), and severe (<82.4°F [ <28°C]) to reflect the different compensatory mechanisms generated at these low temperatures. Hypothermia often implies a bad prognosis.

Differential Diagnosis

• 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

    Treatment

  • ABCs, CPR if patient is pulseless
    • Rewarming
      –Passive external rewarming: Remove cold, wet clothes, dry and insulate patient (ideal for mild hypothermia)
      –Active external rewarming: Hot packs, heating lamps, warmers, warm water baths, electric blankets, and forced-air external rewarming (all controversial, may be responsible for “afterdrop” shifting cold blood from the periphery to the heart)
      –Core rewarming: Heated humidified oxygen, heated IV fluids, heated lavage of cavities (bladder, stomach, peritoneum), extracorporeal blood rewarming
    • Aggressive volume resuscitation using isotonic solutions
    • Monitor heart rate for high possibility of dysrhythmias
    • Glucose infusion for hypoglycemia
    • Antibiotics for sepsis or other severe infection
    '>>

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Temperature symptoms: Introduction (review 1519 causes)
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More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

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