Hypothermia Follow-up

  • Author: Jamie Alison Edelstein, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 27, 2011
 

Further Inpatient Care

Medical complications from hypothermia often result and necessitate admission to the hospital in moderate and severe hypothermia. Severely hypothermic patients should be admitted to an intensive care unit where their respiratory and cardiac function and temperature may be closely monitored.

Acute pulmonary edema should be treated with oxygen, empirical antibiotics for aspiration pneumonia, and diuretics as necessary.

Frostbite and other localized cold injuries result in deep tissue damage. Surgical exploration and debridement may be necessary. Affected body parts may have to be amputated if gangrene develops. Such a procedure is usually performed at some delayed time interval once a line of demarkation has declared itself days to weeks later.

The development of rhabdomyolysis should be monitored.

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Deterrence/Prevention

  • Preparation is key to avoiding accidental hypothermia.
  • Appropriate cold weather clothing and survival bags are a necessity if walking or climbing in a cold climate.
  • Persons should avoid alcohol if anticipating exposure to cold because alcohol can disrupt temperature homeostasis by causing vasodilation.
  • Individuals should remain alert to early symptoms and initiate preventive measures (eg, drinking warm fluids).
  • Adequate heat in the home should be maintained.
  • Patients should be referred to a social service agency for help with adequate housing, heat, and/or clothing.
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Complications

Complications of hypothermia

  • Cardiac arrhythmias at temperatures below 30-32°C
  • Infection
  • Pulmonary edema
  • Bleeding diathesis
  • Bladder atony
  • Electrolyte (hyperkalemia, hypoglycemia), hematocrit, coagulation study abnormalities

Complications of treatment of hypothermia

  • Rewarming shock, or hypotension secondary to marked vasodilatation of rewarming
  • Rewarming acidosis due to recirculation of pooled lactic acid in the peripheral circulation
  • Rewarming electrolyte disturbances, in particular hypocalcemia and hypomagnesemia, indicate a poor prognosis
  • Aspiration pneumonia
  • Pulmonary edema
  • Pancreatitis
  • Burns to cold and vasoconstricted skin secondary to application of hot water bottles and heating pads
  • Neutropenia, thrombocytopenia, and infection
  • Iatrogenic hyperthermia
  • Peritonitis
  • GI bleeding
  • Intravascular thrombosis
  • Gangrene
  • Compartment syndrome
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Prognosis

  • The risk of morbidity and mortality depends on the severity of the degree of hypothermia and the underlying cause.
  • Recovery is usually complete for previously healthy individuals with mild or moderate hypothermia (mortality rate < 5%).
  • The mortality rate for patients with severe hypothermia, especially with preexisting illness, may be higher than 50%.
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Patient Education

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Contributor Information and Disclosures
Author

Jamie Alison Edelstein, MD  Staff Physician, Department of Emergency Medicine, State University of New York, Kings County Hospital Center

Disclosure: Nothing to disclose.

Coauthor(s)

James Li, MD  Former Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Board of Directors, Remote Medicine

Disclosure: Nothing to disclose.

Mark A Silverberg, MD, MMB, FACEP  Assistant Professor, Associate Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate Medical Center

Mark A Silverberg, MD, MMB, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Wyatt Decker, MD  Vice President and Chief Executive Officer, Mayo Clinic Campus, Arizona

Wyatt Decker, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Dan Danzl, MD  Chair, Professor, Department of Emergency Medicine, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

James Steven Walker, DO, MS  Clinical Professor of Surgery, Department of Surgery, University of Oklahoma College of Medicine

James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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Osborne (J) waves (V3) in a patient with a rectal core temperature of 26.7°C (80.1°F). ECG courtesy of Heather Murphy-Lavoie of Charity Hospital, New Orleans.
 
 
 
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