Clinical Features of Accidental Hypothermia, With Some Observations on Thyroid Function

Abstract

Prolonged immobility and sometimes exposure to a cold environment were found to be predisposing causes of accidental hypothermia in a series of 32 elderly patients. Although severe systemic illness is usually a precipitating cause, a low body temperature may itself produce profound nervous and circulatory disturbances. Common clinical conditions associated with accidental hypothermia in this series were bronchopneumonia and cerebrovascular accidents. Severe complications may be masked, and pancreatitis, detected in at least one-third of the patients, was suspected by slight rigidity and tenderness of the abdomen. Myocardial infarction and peripheral gangrene also occurred. The disturbance of consciousness is related to the degree of hypothermia. At temperatures between 90 and 950 F. (32.2 and 350 C.), if death occurred, the cause appeared to be the primary disease and not the hypothermia. The prognosis at temperatures below 900 F. (32.20 C.) was poor, and out of the 32 patients only four recovered completely. Four others, after an initial recovery, died later. High doses of intravenous hydrocortisone are recommended, particularly when consciousness is impaired. In 11 of the patients in vitro tests of thyroid function were carried out. The red-cell uptake of 131I triiodothyronine was in the hyperthyroid range in nine cases, but the serum P.B.I. was abnormally low in three of them. It is suggested that high results in the red-cell-uptake test may occur in accidental hypothermia because of the associated respiratory acidosis or metabolic acidosis. Antibiotics may also interfere with the tests. Several tests of thyroid function should be employed because various factors in hypothermia may interfere with individual tests. © 1964, British Medical Journal Publishing Group. All rights reserved.