Hypothermia

Hypothermia
During Napoleon Bonaparte's retreat from Russia in the winter of 1812, many troops died from hypothermia.[1]
Specialty	Critical care medicine
Symptoms	Mild: Shivering, mental confusion[2] Moderate: No shivering, increased confusion[2] Severe: Paradoxical undressing, muscle rigidity, unconsciousness, cardiac arrest[2] Profound: No obvious vital signs
Complications	Afterdrop
Duration	Until the body temperature is raised to near-normal levels
Types	Primary hypothermia: caused by exposure to a cold environment Secondary hypothermia: caused by an underlying pathology that prevents the body from generating enough core heat.
Causes	Mainly exposure to cold weather and cold water immersion
Risk factors	Alcohol intoxication, homelessness, low blood sugar, anorexia, advanced age,[1][2] injuries and blood loss
Diagnostic method	Based on symptoms or body temperature below 35.0 °C (95.0 °F)[2]
Prevention	Wearing adequate clothes for the weather, staying warm and dry
Treatment	Mild: Warm drinks, warm clothing, physical activity[2] Moderate: Heating blankets, warmed intravenous fluid[2] Severe: Extracorporeal membrane oxygenation, cardiopulmonary bypass[2]
Medication	Sugar
Frequency	frequent in winter months, from November to March (Northern Hemisphere) or May to August (Southern Hemisphere)
Deaths	1,500 per year (US)[2]

Hypothermia is defined as a body core temperature below 35.0 °C (95.0 °F) in humans.^[2] Symptoms depend on the temperature. In mild hypothermia, there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion increases.^[3] In severe hypothermia, there may be hallucinations and paradoxical undressing, in which a person removes their clothing, as well as an increased risk of the heart stopping.^[2]

Hypothermia has two main types of causes. It classically occurs from exposure to cold weather and cold water immersion. It may also occur from any condition that decreases heat production or increases heat loss.^[1] Commonly, this includes alcohol intoxication but may also include low blood sugar, anorexia and advanced age.^[2][1] Body temperature is usually maintained near a constant level of 36.5–37.5 °C (97.7–99.5 °F) through thermoregulation.^[2] Efforts to increase body temperature involve shivering, increased voluntary activity, and putting on warmer clothing.^[2][4] Hypothermia may be diagnosed based on either a person's symptoms in the presence of risk factors or by measuring a person's core temperature.^[2]

The treatment of mild hypothermia involves warm drinks, warm clothing, and voluntary physical activity.^[2] In those with moderate hypothermia, heating blankets and warmed intravenous fluids are recommended.^[2] People with moderate or severe hypothermia should be moved gently.^[2] In severe hypothermia, extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass may be useful.^[2] In those without a pulse, cardiopulmonary resuscitation (CPR) is indicated along with the above measures.^[2] Rewarming is typically continued until a person's temperature is greater than 32 °C (90 °F).^[2] If there is no improvement at this point or the blood potassium level is greater than 12 millimoles per litre at any time, resuscitation may be discontinued.^[2]

Hypothermia is the cause of at least 1,500 deaths a year in the United States.^[2] It is more common in older people and males.^[5] One of the lowest documented body temperatures from which someone with accidental hypothermia has survived is 12.7 °C (54.9 °F) in a 2-year-old boy from Poland named Adam.^[6] Survival after more than six hours of CPR has been described.^[2] In individuals for whom ECMO or bypass is used, survival is around 50%.^[2] Deaths due to hypothermia have played an important role in many wars.^[1]

The term is from Greek ῠ̔πο (ypo), meaning "under", and θέρμη (thérmē), meaning "heat". The opposite of hypothermia is hyperthermia, an increased body temperature due to failed thermoregulation.^[7][8]