Today in
morning report we discussed the case of a patient who presented with
hypothermia. We don't come across this every day in GIM so
it is good to review the causes. Hypothermia is defined as a temperature less
than 35 degrees Celsius. It is important to consider getting a second reading
from a different body site to confirm that this is a true reading.
Environmental
exposure is a common cause of hypothermia which can usually be elicited from
the history. However, sometimes there is no history of cold exposure. In these
cases you should think about the other causes of hypothermia. You can divide
these into broad categories [that relate to the reasons your house might be too
cold]:
Increased
heat loss [the doors/windows are open]
- Drugs that cause vasodilatation (drugs, alcohol)
- Iatrogenic causes (cold infusions, CRRT, bypass)
- Burns or severe skin conditions (psoriasis)
Reduced
heat production [the furnace is not working properly]
- Endocrine causes (hypothyroidism, adrenal insufficiency, hypopituitarism)
- Hypoglycemia
- Malnutrition
- Reduced muscle activity (extreme elderly, inactivity)
Impaired
regulation [the thermostat is incorrectly set]
- Central CNS pathology (Stroke, intracranial hemorrhage, hypothalamic dysfunction, parkinsonism, MS, CNS drugs
- Peripheral CNS pathology (spinal cord transection)
Miscellaneous
causes [your house has an infection? ok, this one doesn’t apply to the house
analogy]
- Sepsis
- Pancreatitis
Check out the following article for a nice review of hypothermia: http://www.aafp.org/afp/2004/1215/p2325.html
7 comments :
Good for self inspection and diagnosis. Are there any device can help the process? -BOC Sciences
Waiting for more details about the "Increased heat loss" part.
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