| hypothermia is a dangerous situation. It is defined by a core temperature of less than 35 degrees C. Aggressive rewarming is used if it is lower than 30 degrees C, comprising extracorporeal therapies. A case of a 63 year old lady is reported whose temperature was 21.8 degrees C, circulation was unstable, respiratory insufficiency prevailed and severe neurological dysfunction. serum potassium was 2.9 mmol/l and pH corrected for temperature 7.61. The patient was rewarmed by hemofiltration (HF) over 6 hours with substitution of 18 l of a solution containing a concentration of potassium of 5 mmol/l. Though potassium levels declined initially and than slowly normalized in 9 hours there were no arrhythmias documented. The ECG showed prolongation of the PQ-, QRS-, and especially the QT-times. All clinical and neurological sequelae had disappeared after four days. HF thus seems to be a safe method of rewarming in very severe hypothermia. ( info) |
302/334. Resuscitation from cardiopulmonary arrest during accidental hypothermia due to exhaustion and exposure. A 16-year-old boy with accidental hypothermia and cardiopulmonary arrest due to exhaustion and exposure was resuscitated after warming measures -- hot wet towels, hot water bottles, and hot water enemas and gastric lavage -- had increased his rectal temperature from 25.2 to 28.0 degrees C. Despite prolonged cardiopulmonary arrest, recovery was almost complete, with no evident cerebral damage. cardiopulmonary resuscitation procedures should not be abandoned until the body temperature is more than 30 degrees C, because the prognosis in cases of accidental hypothermia without associated disease is excellent if cardiac function can be re-established. ( info) |
| hypothermia occurs when the core body temperature falls below 95 degrees F (35 degrees C). Several conditions which can occur in the psychiatric population increase the risk of hypothermia: nocturnal enuresis, seizure disorder, debilitating physical illness, and mental retardation. The risk of hypothermia is further increased by the use of several classes of medications used to treat psychiatric disorders: antipsychotics, beta-adrenergic antagonists, benzodiazepines, and other sedatives. air-conditioning is also identified as a risk factor for hypothermia. hypothermia is posited as a possible link between antipsychotic medication and sudden unexplained death. Suggestions for further investigation are made, and clinical recommendations are offered to reduce the risk of hypothermia in the psychiatric patient population. ( info) |
304/334. Recurrent coma. Recurrent episodes of coma are usually associated with a metabolic disorder. A healthy 9-year-old boy of normal intellect and intact corpus callosum on neuroimaging had recurrent episodes of coma associated with profound spontaneous hypothermia. An evaluation, differential diagnosis and insights into the pathogenesis of this disorder are discussed. ( info) |
| The authors describe an infant with Down's syndrome who had a prepyloric web complicated by severe gastric outlet obstruction. The delay in diagnosis was responsible for malnutrition and the early postoperative complications of hypothermia and hypoglycemia. awareness of the association of gastrointestinal abnormalities with Down's syndrome will enable appropriate evaluation for early diagnosis of this surgically correctable malformation. ( info) |
| Five patients with clinically definite multiple sclerosis are reported who presented with acute relapses associated with hypothermia. Repeated episodes of hypothermia were seen in four. thrombocytopenia was associated with the hypothermia in four patients. Further investigation disclosed a tendency to chronic hypothermia and suggested an altered thermoregulatory set point in one patient, when MRI, endocrine, and autonomic studies failed to localise a lesion in the hypothalamus, but subsequent necropsy showed hypothalamic lesions. In such patients a predisposition to altered thermoregulation may occur due to direct involvement of the hypothalamus or from combined lesions affecting hypothalamic outflow to the brainstem and spinal cord. ( info) |
| A patient with central nervous system and systemic sarcoidosis had profound hypothermia and dementia with associated lymphadenopathy and hypernatremia. His capacity to develop fever remained; despite the persistent marked hypothermia, sweating and shivering in response to peripheral heating and cooling were maintained. Postmortem neuropathologic studies indicated that the hypothalamic region, generally considered to contain the primary temperature control, had been severely damaged by granulomatous sarcoid disease. These results confirm and extend previous findings of temperature disturbance in hypothalamic sarcoidosis and suggest that the integrity of the primary control of body temperature is not essential to fever production and "broad-band" regulation against environmental temperature extremes. ( info) |
308/334. Acute shortness of breath: an unusual cause. A case of cold induced pulmonary oedema in a scuba diver is described. This is rare, but with the increasing popularity of the sport it is important for accident and emergency staff to be aware of the condition. Treatment is symptomatic and the outlook is good. ( info) |
309/334. Profound accidental hypothermia in the deep South: clinical experience. Accidental hypothermia resulting from exposure is generally associated with frigid regions and not with the more temperate areas of the South. However, we present clinical experience from two cases in which the victims of motor vehicle accidents were exposed to the elements for prolonged periods and became profoundly hypothermic. The first patient was a 21-year-old male who was ejected from, and pinned under, his vehicle for approximately four hours in -15 degrees C ambient temperature. Upon admission to the Emergency Room, the patient was unresponsive with fixed and dilated pupils and his core temperature was 25 degrees C. After a prolonged period of cardiopulmonary resuscitation, percutaneous femoral to femoral cardiopulmonary bypass (CPB) was instituted for core rewarming. After reaching 37 degrees C, the patient was removed from bypass. The patient was discharged from the hospital on the fourth postoperative day. The second patient was a 40-year-old male who was ejected from his vehicle into a stream, where he was partially submerged for several hours. Although the ambient temperature was approximately 22 degrees C, his core temperature at admission was 27 degrees C. After a positive peritoneal lavage, the patient was taken to the Operating Room and placed on percutaneous femoral to femoral CPB for core rewarming. During rewarming, an exploratory laparotomy and a splenectomy were performed. The patient was discharged from the hospital on the seventh postoperative day. These cases are unique in that both were trauma patients with suspected internal injuries which required the avoidance of anticoagulation. Therefore, both cases utilized a Carmeda-bonded circuit without systemic anticoagulation. ( info) |
310/334. Maternal hypothermia and persistent fetal bradycardia during the intrapartum process. Maternal hypothermia can be correlated with persistent fetal bradycardia. The improvement of the maternal hypothermic state and the subsequent alleviation of fetal bradycardia are presented in two case reports. A possible consequence of unrelieved maternal hypothermia at delivery, neonatal cold stress, is discussed in a third case report. Neonatal complications requiring interventions may ensue after cold stress. ( info) |