“Paradoxical Undressing”in Fatal Hypothermia

Abstract

Death from exposure to cold presents one of the threats to the survival of man in arctic and subarctic regions. Yet we do not have much actual knowledge of the clinical events leading to fatal hypothermia. Apart from the experiments performed by the Nazis at the Dachau concentration camp [1] most of our knowledge has to be gathered from such sources as memoirs, historical accounts, police reports, and hospital files.

?Terminal burrowing behaviour? ?a phenomenon of lethal hypothermia

“…In 17 cases (25%) ( [23]:17%, [43]:75%) the bodies were found inadequately clothed (n = 12) or completely naked (n = 5) [8,10,14,23,49]. In most cases, the clothes were strewn on the ground beside the body, sometimes forming a trail of scattered clothing over a distance of some metres.…”

“…The reason for the frequent obscurity of scenes at cases of lethal hypothermia is mainly due to the phenomenon of the so-called paradox reaction [8,10,14,23,49]. In many cases the bodies were found partly or completely unclothed and abrasions and haematomas are found on the knees, elbows, feet, and hands [8,23].…”

Wilderness medicine

“…"Paradoxic undressing" is thought to be caused by cutaneous vasodilation and alterations in cognition; "terminal burrowing" might be a primitive refl ex. [65][66][67] The basics of hypothermia resuscitation include prevention of further heat loss, rewarming, and support of physiologic processes. [68,69] Field research with healthy subjects and invasive monitoring has clarified the physiology of cooling and afterdrop.…”

Lethal hypothermia – a sometimes elusive diagnosis

“…As with cases of hyperthermia, the core temperature of a decedent at the time of death is not usually available, and so evaluation of potential cases at autopsy requires a clear understanding of the circumstances of the death (ideally with a recording of the ambient temperature) and the exclusion of other possibilities [3,8,16]. Issues occur with differences in diagnostic practices arising from the nonspecific and subtle nature of findings at autopsy, and the possibility of inflicted injury due to the sometimes bizarre nature of behavior that may occur before death [17][18][19]. Biochemical markers are not currently routinely assessed in these cases [2,20].…”

“…This has been called "hypothermic confusion" and results from terminal failure of thermoregulatory control [4,8]. Socially isolated individuals may also exhibit features of the "hide and die" syndrome or "terminal burrowing" where they may be found hidden under a pile of newspapers or rubbish [17,21]. This is most likely in hoarding disorders as a manifestation of Diogenes, Havisham, or so-called senile squalor, syndrome [22,23].…”