Hypothermia: Evaluation, Electrocardiographic Manifestations, and Management

Aslam, Ahmed F.; Aslam, Ahmad Kamal; Vasavada, Balendu C.; Khan, Ijaz A.

doi:10.1016/j.amjmed.2005.09.062

Cited by 132 publications

(88 citation statements)

References 32 publications

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“…La destrucción del tejido muscular inducida por el etanol se justifica por diferentes mecanismos fisiopatológicos: inmovilización prolongada del paciente, anomalías electrolíticas y toxicidad directa 2 . En el caso que exponemos podrían estar implicados la toxicidad directa mediada por inducción del citocromo p450 3 , así como la posible hipotermia que ha sido descrita como inductora de rabdomiolisis 4 , y que debió sufrir el paciente aunque no estaba hipotérmico a su llegada a nuestro centro pues se había iniciado calentamiento en el centro de Atención Primaria. Otras drogas y tóxicos (metanol, etilenglicol, heroína, cocaína, metadona, barbitúricos, benzodiacepinas, cafeína, anfetaminas, LSD, éxtasis, fenciclidina, tolueno) han sido descritos como causa de rabdomiolisis.…”

Section: Discussionunclassified

Rabdomiolisis secundaria a intoxicación etílica: Caso clínico

et al. 2013

Rev. chil. pediatr.

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Rhabdomyolysis following alcohol intoxication: a case reportIntroduction: Rhabdomyolysis is a potentially lethal syndrome characterized by disintegration of striated muscle fibers. In children Rhabdomyolysis is caused mostly by trauma, nonketotic hyperosmolar coma, viral myositis, dystonia and malignant hyperthermia. Case report: A 14 year old male was brought into the emergency room because of a decreased level of consciousness following alcohol and cannabis. An initial assessment indicated the presence of hypothermia and a Glasgow Coma Scale of 9. A blood biochemical analysis showed a mixed acidosis and CPK levels of 12260 U/L (CK-MB 132 U/L). After diagnosing alcohol induced coma and rhabdomyolysis, intravenous fluids and urinary alkalinization are administered. The patient presented a rapid neurological improvement reaching normal within 12 hours. He remained normotensive, adequate diuresis, negative balances, normal blood gas values and urine test strips presented no pathological changes. A maximum level of serum CPK was observed 24 hours after ingestion (20820 U/L), with subsequent decline to 6261 U/L at day 5, once he was discharged. Discussion: Alcohol poisoning is a rare cause of rhabdomyolysis in Pediatrics. The main therapeutic goal is to prevent acute renal failure, aggressive fluid therapy and urine alkalinization then must be administered, monitoring possible electrolyte abnormalities and the presence of myoglobinuria. In conclusion, rhabdomyolysis is one of the possible complications after alcohol poisoning. Given its potential morbidity, it should always be considered.

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Section: Discussionunclassified

Rabdomiolisis secundaria a intoxicación etílica: Caso clínico

et al. 2013

Rev. chil. pediatr.

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“…Treatment includes both general supportive measures and specific rewarming techniques [12]. Oxygen and intravenous fluids should be warmed, and patients should have constant monitoring of their core temperature, cardiac rhythm, oxygen saturation and glucose levels.…”

Section: Follow-upmentioning

confidence: 99%

Hypothermia: an under-estimated risk

Caroselli

Gabrieli

Pisani³

et al. 2009

Intern Emerg Med

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Case presentationProf. Bruno: A 80-year-old woman was found unconscious in the street from a passer-by. It was a cold January morning, and the patient had slept outdoor. She was a homeless known in the Emergency Department (ED) as an alcohol abuser.When she was admitted to the ED, she presented with stupor and apathy. She spoke very slowly, and her speech patterns were vague and slurred. Physical examination revealed that the skin was very cold, even on the torso; and there was marked pallor. The rectal body temperature was 29°C.She had an abnormally slow rate of breathing (8 breaths/ min), and the non-invasive SO 2 was 86% on room air, and 96% after the administration of Oxygen by mask (6 L min -1 ). Blood pressure was 85/50 mmHg, and the pulse was 40 beats/min, and very weak. The 12-lead ECG showed sinus bradycardia at about 40 beats/min, and there were prominent J waves (Osborn Wave). Hemogasanalytic values were normal. A Glasgow Coma Scale (GCS) score was 10. The patient underwent oro-tracheal intubation to provide airway protection. The finger-stick glucose was normal (108 mg %). The laboratory tests were within normal ranges except for a hyponatremia (120 mmol/L). We hypothesize the hyponatremia was due to volume depletion.Our working diagnosis was accidental hypothermia. We immediately removed her wet cold clothing, and we covered the patient with an electric blanket. She was given warm saline fluids intravenously. Because she was classified as severe hypothermia with a high risk for cardiac arrest, she underwent extra-corporeal treatment by emergency haemodialysis to actively rewarm her blood rapidly outside the body. In this way it was possible to restore normal body temperature rapidly. This invasive method of rewarming permitted us to restore a normal core temperature providing safe treatment.The patient left the hospital after several; days in good health. We advised her to avoid sleeping outside, to adequately cover her body including extremities and particularly the head. Differential diagnosisDr. Caroselli, Dr. Pisani: There are many causes of hypothermia. Often decreased thermogenesis is secondary to an endocrinologic failure such as hypopituitarism, hypoadrenalism, or myxedema, it may be due to alcohol or drug intoxication.Among metabolic disorders, a frequent cause of hypothermia includes hypoglycaemia that may occur from a glycogen store depletion. Blood glucose determination is

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“…Hipotermik hastalarda kalp kas› ritm bozukluklar›na afl›r› derecede duyarl›d›r. Hastan›n kaba hareketlerle muayenesi bile disritmilere yol açabilir (8,9) . (8,10) .…”

Section: Kl‹n‹kunclassified

Hipotermi Değerlendirmesi, Tanı Ve Tedavisi

Eren¹,

Korkmaz²,

Doğan³

et al. 2009

jaem

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SUMMARYBody temperature below 35ºC is defined as hypothermia. It is classified as mild, moderate and severe. While the standard thermometers can not measure the core temperature below 35ºC, thermometers with intravezical, rectal or esophageal probes must be used to determine the core temperature in hypothermic patients. Although hypothermia is seen in cold climates; it can be seen because of environmental conditions, like drowning, too. Also inadequate clothing and hypothermia background can facilitate hypothermia in patients. The common causes for hypothermia are dermatological disease, drug adverse effects, iatrogenic causes, neurological disease, neuromuscular insufficiency, sepsis and metabolic condition of the patient. Resistance to cold in the peoples is not well developed while they are warm-blooded. Especially homeless, psychiatric and lonely elderly people can be affected by hypothermia easily. Although the main heat loss of the body is by radiation; conduction, convection and evaporation take place too. Coordination and consciousness deficiencies are the main symptoms. Nevertheless clinical signs vary according to the hypothermia state. The basic treatment principles resemble each other in mild, moderate and severe hypothermia. These are; reducing of the heat loss, warming of the body with internal and external ways, supplying the main energy and fluid demands for patient metabolism. The defibrillation techniques, resuscitation time and the drugs which are used are different in hypothermic cardiopulmonary resuscitation than normal cardiopulmonary resuscitation. The main systems which are damaged from hypothermia are cardiovascular and central nervous system. That's why early and true diagnosis and aggressive treatment has a great importance for surviving. ÖZETHipotermi vücut merkez s›cakl›¤›n›n 35ºC 'nin alt›na düflmesi olarak tan›mlan›r. Hafif, orta ve a¤›r olmak üzere üç ayr› kategoride s›n›fland›r›l›r. Standart termometreler 35ºC'nin alt›n› ölçemediklerinden; vücut merkez ›s›s› (iç ›s›), rektal, intravezikal veya özefagus probu olan termometrelerle ölçülür. Hipotermi s›kl›kla so¤uk iklimlerde görülse de bo¤ulma gibi çevresel etmenlere ba¤l› da geliflebilir. Ayr›ca yetersiz giyinme ve daha önceden hipotermi öyküsünün bulunmas› kolaylaflt›r›c› etmenlerdir. Hipoterminin s›k nedenleri aras›nda cilt hastal›klar›, ilaç yan etkileri, iyatrojenik nedenler, metabolik durumlar, nörolojik hastal›klar, nöromuskuler yetersizlik ve sepsis vard›r. ‹nsanlar s›cak iklime uygun canl›lar oldu¤undan hipotermiye dayan›kl›l›klar› geliflmemifltir. Özellikle evsizler, kimsesiz yafll›lar ve ak›l hastalar› hipotermiye ba¤l› zararlanmalara kolayl›kla u¤rayabilirler. Vücuttan ›s› kayb› en fazla radyasyon yoluyla olmak üzere, kondüksiyon, konveksiyon ve evaporasyonla da olmaktad›r. Hipotermik hastalarda özellikle bilinç ve koordinasyon bozukluklar› temel semptomlard›r. Bununla beraber klinik bulgular hipoterminin evresine göre de¤iflkendir. Hafif, orta ve a¤›r düzeydeki hastalar›n tedavi ilkeleri benzerlik gösterir. Bunlar vücu...

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Hypothermia: Evaluation, Electrocardiographic Manifestations, and Management

Cited by 132 publications

References 32 publications

Rabdomiolisis secundaria a intoxicación etílica: Caso clínico

Rabdomiolisis secundaria a intoxicación etílica: Caso clínico

Hypothermia: an under-estimated risk

Hipotermi Değerlendirmesi, Tanı Ve Tedavisi

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