Key messages

• Hypothermia is defined as a core temperature below 35 °C.

• When hypothermia develops unintentionally it is known as accidental hypothermia.

• In cold surroundings, the thermoregulatory mechanisms are set in gear to prevent heat loss and to increase heat production; immediate peripheral vasoconstriction and intense muscle shivering take place, and thyroid gland activation supervenes later.

• Accidental hypothermia can develop either in healthy individuals faced with extreme climatic conditions or in patients with abnormal thermoregulatory mechanisms.

• During hypothermia, enzymatic and biochemical reactions slow down, oxygen consumption falls, and the metabolic rate is very low.

• Hypothermia depresses all organ and system functions, resulting in decreased heart rate, blood pressure, and cardiac output, shock, bradypnea, confusion, muscle hypotony and rigidity, decreased gastrointestinal motility, and oliguria.

• Extremely severe hypothermia can mimic death with cardiorespiratory arrest, muscle rigidity, coma, and areactive dilated pupils, with no recordable activity on the electrocardiogram and electroencephelogram.

• An apparently dead hypothermic patient may survive after rewarming.

• Hypokalemia is expected during hypothermia. Extreme hyperkalemia in an apparently dead hypothermic patient may be a biological marker of death. Definition

Hypothermia is defined as a core temperature (rectal, esophageal, tympanic, or central venous) below 35 °C. It can be induced for therapeutic purposes (cardiovascular surgery, brain protection). However, it may develop unintentionally, when it is known as accidental hypothermia. It is usual to classify accidental hypothermia as mild (35-32 °C), moderate (< 32-28 °C), or severe (< 28 °C). If the temperature is above 32°C, morbidity is not due to hypothermia but to the underlying disease. In contrast, hypothermia below 32 °C may itself be fatal with a mortality of up to 80 per cent.

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