Treatment of Hypothermia

Treatment of hypothermia must be prompt and the aim of treatment of hypothermia is to bring the body temperature to normal as soon as possible without compromising or causing any serious complication.

If a patient’s body temperature is low (hypothermia) most of the target organs for drugs and the cardiovascular system do not respond adequately to drugs. As drugs do not respond adequately there may be a tendency to administer repeated doses or higher doses which may cause cumulative toxicity during re-warming. During hypothermia drugs tend to bind more to plasma proteins, there is reduced metabolism as well as reduced excretion of drugs, than for a normal body temperature individual. For example, during hypothermia even repeated doses of insulin (for diabetics) or digoxin (for heart failure patients) may not be effective, but during re-warming (treatment of hypothermia), they may lead to potentially serious toxicity.

Treatment/management of hypothermia:

The aim of treatment of hypothermia is to re-warm patient, bring blood pressure to normal (as hypothermia patients are hypotensive), control arrhythmia and other associated symptoms.

Initially hypotension (low blood pressure) should be managed with crystalloid/colloid infusion and re-warming. If no improvement with infusion of crystalloid/colloid and re-warming, low dose dopamine (2-5 microgram per kg body weight per minute) may be considered. For improving perfusion in vasoconstricted cardiovascular system, low dose intravenous nitroglycerine may be used.

Atrial arrhythmia should be observed without any intervention, because ventricles with lower rate will control the heart rate and re-warming will bring arrhythmia under control. Management of arrhythmia for hypothermia patient is very troublesome, as none of the anti-arrhythmic agents are safe.

Hypothermia can musk most of the signs and symptoms (such as fever, rigors etc.) of infection. Extensive cultures (blood culture, urine culture etc.) should be advised, except few selected cases of mild hypothermia. For elderly, neonates, and immunocompromized patients with hypothermia, empirical antibiotic therapy should be administered, unless a clear infection is identified.

Prevention of hypothermia:

Preventive measure include discussion and emphasis on use of adequate warm clothing by susceptible individuals (e.g. elderly individuals) whose work regularly expose them to cold (extreme cold). Emphasis should be given about the importance of using layered clothing, use of appropriate headgear, appropriate shelter, increased calorie intake and avoidance of alcohol intake.

 

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