How To Treat Hypothermia

How to treat hypothermia patients depends on the condition of the patient and type of hypothermia, i.e. if the patient is suffering from primary hypothermia or if the patient suffering from secondary hypothermia, due to some other severe systemic disorder that may cause secondary hypothermia.

Hypothermia is fall of core body temperature to below 95 degree Centigrade or 95 degree Fahrenheit. If a patient develop hypothermia, most of the medications have minimal effect on cardiovascular system and the target organs for medications. Hence, use of any medication may not be effective for treatment of hypothermia. Moreover repeated use of medication(s) in a hypothermic patient during rewarming may cause accumulation of medication (because during rewarming drug binding to proteins is increased and there is also reduced metabolism and reduced excretion of drugs), which may lead to cumulative toxicity.

The most important part of treatment or management of hypothermia is rewarming of patient with hypothermia. The rate of rewarming should aim to increase body temperature 0.5 degree Centigrade to 2.0 degree Centigrade per hour. Without proper rewarming other medications has to be used very cautiously.

Main aims of treatment of hypothermia:

  • The first objective of treatment of hypothermia should be aimed to achieve mean arterial pressure of 60 mmHg in the beginning. If hypotension (low blood pressure) of patient does not respond to rewarming and use of warm (40 to 42 degree Centigrade) colloid/crystalloid, use of low dose dopamine (2-5 microgram per kg per minute) should be considered.
  • Atrial arrhythmia should be carefully monitored without any intervention. Rewarming corrects it in most of the cases. Ventricular arrhythmia can be treated with bretylium tosylate, if available, which is a class III ventricular antiarrhythmic of choice in hypothermia with ventricular arrhythmia. The role of prophylactic use of antiarrhythmic drug is controversial.
  • Empirical therapy (non-specific treatment used before specific cause is identified) for adrenal insufficiency is not recommended unless there is history of steroid dependence, hypoadrenalism, or a failure to rewarm with standard rewarming.
  • Hypothermia may mask signs and symptoms of infection, such as fever and high white blood cell count, hence, other than mild cases of hypothermia all other cases should be subjected to repeated physical examinations and extensive culture of various body fluid (blood, urine, CSF etc.).

How to treat hypothermia depends on individual patients and no treatment can be generalized for all patients. But the most important treatment for hypothermia is rapid rewarming.

Image courtesy of imagerymajestic / FreeDigitalPhotos.net

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