Acute Pancreatitis and Diabetic Ketoacidosis in Accidental Hypothermia and Hypothermic Myxoedema

Maclean, Derek; Murison, J.; Griffiths, Peter

doi:10.1136/bmj.4.5895.757

Cited by 62 publications

(20 citation statements)

References 27 publications

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“…This was the only patient in whom ethanol was found in the plasma; there were no known patients with chronic alcoholism or other drug abusers in the series. Our patients differed from others described elsewhere (Maclean et al, 1973;Maclean, Griffiths, Browning & MuriSon, 1974) in that most had not been neglected. This was shown by the short duration of the cooling period in many of them, the absence of gross clinical malnutrition and the relatively normal concentration of the plasma proteins (deposited Table 80/1).…”

Section: Resultscontrasting

confidence: 77%

Metabolic Aspects of Hypothermia in the Elderly

et al. 1980

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1. Plasma concentrations of glucose, lactate, amino acids, non-esterified fatty acids, glycerol, ketone bodies, insulin and cortisol were measured in 43 elderly patients with hypothermia. In 15 of these patients forearm arteriovenous differences were also measured. Core temperatures ranged from 25.9 to 35.5 degrees C. 2. The metabolic state was of mobilization of glycogen and triacylglycerol stores, with high plasma concentrations of lactate and lipid metabolites. The plasma concentration of glucose was raised in those with hypothermia of a short duration (less than 6 h). In other patients it was low in those with core temperatures around 30 degrees C, but below this temperature it was variable and often high. Concentrations of other metabolites or hormones were not related to core temperature. 3. Plasma concentrations of cortisol were high and positively correlated with those of lactate and glycerol, suggesting active involvement in stimulation of muscle glycogenolysis and of lipolysis. 4. Plasma concentrations of insulin ranged from very low to very high and appeared to depend on the concentrations of both glucose and alanine. 5. Arteriovenous differences were generally small. There was peripheral release of lactate and of amino acids but no overall peripheral uptake of glucose. In nine out of 15 patients there was a significant peripheral release of glucose.

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Section: Resultscontrasting

confidence: 77%

Metabolic Aspects of Hypothermia in the Elderly

et al. 1980

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“…[41][42][43] Nevertheless, in clinical practice, some authors have found hyperamylasemia in hypothermic patients. 44,45 Moreover, in an evaluation of 20 patients with accidental hypothermia admitted to ICU for causes other than those related to acute pancreatitis, Lichtenstein et al 13 found hyperamylasemia in 8/9 patients and necrohemorrhagic pancreatitis in 1/2 autopsies.…”

Section: Discussionmentioning

confidence: 99%

Oxidative Stress Is Enhanced by Hypothermia Imposed on Cerulein-Induced Pancreatitis in Rats

Andraus

Jukemura

Dutra

et al. 2007

Clinics

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MC. Oxidative stress is enhanced by hypothermia imposed on cerulein-induced pancreatitis in rats. Clinics. 2007;62(4): 483-90. BACKGROUND:Hypothermia is a frequent event in severe acute pancreatitis (AP) and its real effects on the normal pancreas have not been well demonstrated. Moreover, neither have its effects on the outcome of acute pancreatitis been fully investigated. One hypothesis is that oxidative stress may be implicated in lesions caused or treated by hypothermia. Aim of the study: To investigate the effect of hypothermia in cerulein-induced acute pancreatitis (CIAP) in rats and the role played by oxidative stress in this process. METHODS: Male Wistar rats were divided into hypothermic and normothermic groups. Hypothermia was induced with a cold mattress and rectal temperature was kept at 30 o C for one hour. Acute pancreatitis was induced with 2 doses of cerulein (20 ìg/kg) administered at a one-hour interval. Serum amylase, pancreas vascular permeability by Evan's blue method, pancreas wet-to-dry weight ratio and histopathology were analyzed in each group. RESULTS: When compared with normothermic rats, hypothermic animals, with cerulein-induced acute pancreatitis, showed higher levels of pancreatic vascular permeability (P < 0.05), pancreas wet-to-dry weight ratio (P = 0.03), and histologically verified edema (P < 0.05), but similar serum amylase levels. The hypothermic group showed a higher oxidized-reduced glutathione ratio than the normothermic group. CONCLUSION: Moderate hypothermia produced a greater inflammatory response in established acute pancreatitis induced by cerulein in rats. Moreover, this study suggests that oxidative stress may be one of the mechanisms responsible for the worse outcome in hypothermic rats with cerulein-induced acute pancreatitis.

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“…Although patients usually lack symptoms of acute pancreatitis, over 50% have amylase elevations above 550 Somogyi units. Moreover, up to 80% of patients who die of hypothermia have evi- ' dence of pancreatitis at autopsy [86]. The relationship between alcohol use and pancreatitis in these patients is unclear.…”

Section: Pathophysiolo~ymentioning

confidence: 99%

Disorders of Temperature Control: Hypothermia, Part III

Curley

Irwin

1986

J Intensive Care Med

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Hypothermia, defined as a body core temperature below 35°C, results from exposure to cold, drugs, metabolic dysfunction, or nervous system or skin disorders. The diagnosis and clinical assessment of patients with hypothermia should be based on a thorough knowledge of the characteristic physiologic changes that accompany hypothermia and affect all organ systems. Morbidity and mortality resulting from hypothermia may be reduced when physicians anticipate the well-known complications of hypothermia and carefully rewarm the patient.The rate and method of rewarming must be individualized, taking into account available resources and the patient's cardiopulmonary status and underlying disease.In Parts I and II of this review, the normal physiology of temperature regulation and three hvperthermic syndromes-heat stroke, malignant hyperthermia, and neuroleptic malignant syndrome-were reviewed. This section focuses on unintentional hypothermia and reviews in detail its pathogenesis, pathophysiologic factors, diagnosis, and management. Iatrogenic and intentional hypothermia in the perioperative setting is briefly discussed.Hypothermia, defined as a core temperature below 35°C, is not uncommon; it occurs at all ambient temperatures and in patients of all ages, although more commonly in the elderly. During the winter in Great Britain, 0.7% of all hospital admissions [1], 3% of elderly patients admitted [2], and at least 10% of otherwise healthy elderly individuals examined at home [3] had core temperatures in the hypothermic range. Review of death certificates in the United States reveals an average mortality rate for hypothermia of 0.22 per 100,000 individuals; white women have the lowest rates, and nonwhite men, the highest [4]. When all data are reviewed, the overall mortality from hypothermia in the United States has been conservatively estimated at 17 deaths per million of the general population peryear {5]. The mortality rate for treated hypothermia ranges from 12% [6] to 73% [7]. Cause and PathogenesisAlthough hypothermia can occur in all climates, at nearly all ambient temperatures, and at every age, the most frequent causes (vide infra) appear to be exposure, use of depressant drugs, and hypoglycemia. The elderly, because of a &dquo;normal&dquo; impairment of regulatory function, constitute a large portion of the patients who become hypothermic. A brief review of the causes of hypothermia (Table 1) at UNIVERSITE LAVAL on July 1, 2015 jic.sagepub.com Downloaded from 271 Table 1. Causes of Hypothermia and their pathogenesis will help develop a rational approach to treatment.Exposure to Cold Fatal hypothermia occurs frequently, even in the healthy young adult who simply has been overexposed to the elements. Wet, wind, and exhaustion contribute to increased loss of body heat. Wet clothing loses 90% of its insulating value [8], rendering soaked individuals effectively nude. Exposure to rain or snow was believed to contribute greatly to the development of hypothermia in 15 of 23 incidents in hikers discussed in one rev...

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Acute Pancreatitis and Diabetic Ketoacidosis in Accidental Hypothermia and Hypothermic Myxoedema

Cited by 62 publications

References 27 publications

Metabolic Aspects of Hypothermia in the Elderly

Metabolic Aspects of Hypothermia in the Elderly

Oxidative Stress Is Enhanced by Hypothermia Imposed on Cerulein-Induced Pancreatitis in Rats

Disorders of Temperature Control: Hypothermia, Part III

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