Cases Of Hypothermia Research Articles

A case of severe hypothermia with acute suppurative cholangitis resulting in bradycardia and cardiac arrest during rewarming

A case of severe hypothermia with acute suppurative cholangitis resulting in bradycardia and cardiac arrest during rewarming

The Importance of BHB Testing on the Post-Mortem Diagnosis of Ketoacidosis.

Although beta-hydroxybutyrate (BHB) analysis has proved its importance in forensic pathology, its effects on cause-of-death diagnostics are unaddressed. Therefore, this study aims at evaluating the effects of BHB analysis on the number of deaths by DKA (diabetes ketoacidosis), AKA (alcoholic ketoacidosis), HHS (hyperosmolar hyperglycaemic state), hypothermia, diabetes, alcoholism, and acidosis NOS (not otherwise specified). All 2900 deaths from 2013 through 2019 in which BHB was analysed at the National Board of Forensic Medicine, and 1069 DKA, AKA, HHS, hypothermia, diabetes, alcoholism, and acidosis cases without BHB analysis were included. The prevalence of BHB-positive cases for each cause of death, and trends and proportions of different BHB concentrations, were investigated. The number of BHB analyses/year increased from 13 to 1417. AKA increased from three to 66 and acidosis from one to 20. The deaths from alcoholism, DKA, and hypothermia remained stable. It is unclear why death from alcoholism remained stable while AKA increased. The increase in unspecific acidosis deaths raises the question why a more specific diagnosis had not been used. In conclusion, BHB analysis is instrumental in detecting AKA and acidosis. The scientific basis for the diagnosis of DKA and hypothermia improved, but the number of cases did not change.

Characteristics of antipsychotic drug-induced hypothermia in psychogeriatric inpatients.

Hypothermia is a potentially lethal adverse reaction to typical and atypical antipsychotic drugs (APD). Among predisposing factors are advanced age and comorbid somatic diseases. The aim of this study was to assess the incidence of hypothermia and quantify risk factors. Charts of N=3002 psychogeriatric inpatients were screened for incidence of hypothermia (body core temperature <35.0°C). The frequency of hypothermia was compared between patients treated with versus without APD and, within the sample of APD-treated patients, for (1) specific APD, (2) sex, (3) main diagnosis, and (4) age. N=54 cases (2.6%) of hypothermia occurred in APD-treated patients and 12 cases (1.3%) in non-APD-treated patients (p=0.024). In APD-treated patients, only male sex (p=0.038) and pipamperone were associated with a higher incidence of hypothermia (p=0.0017). Whereas the main diagnosis delirium showed a trend to significance, age did not correlate with hypothermia. Medication with pipamperone was associated with an increased risk of hypothermia. The advanced age of our sample might as well explain the high incidence of hypothermia within our sample and the failure to detect high age as a risk factor due to a ceiling effect.

Hypothermia causes platelet activation in the human spleen

BackgroundAccidental hypothermia results in various dysfunctions in the human body. Additionally, coagulation disorder can lead to a life-threatening condition. We previously demonstrated that platelets stored in the spleen were activated and thus triggered coagulation disorder in a mouse model of hypothermia. In the present study, we wanted to investigate if this phenomenon in mice also occurs in humans as a reaction to hypothermia. MethodsWe analyzed splenic tissue collected from 22 deceased subjects who have died from hypothermia. These samples were compared with 22 control cases not exposed to cold environment. We performed immunohistochemical staining for CD61 (a marker of all platelets) and CD62P (a marker of activated platelets). We also evaluated the morphology of platelets in the spleen with scanning electron microscopy. ResultsImmunohistochemical analysis revealed no significant changes in the amounts of CD61-positive platelets between the hypothermia and control cases. However, the hypothermia cases contained abundant CD62P-positive platelets compared with those of the control cases. Immunohistochemical analysis also revealed that the activated platelets formed aggregates and adhered to splenic sinusoidal endothelial cells in the hypothermia cases. However, we observed no significant fibrin formation around the activated platelets. ConclusionsHypothermia resulted in splenic platelet activation, which may be used as a postmortem marker of hypothermia. The release of activated platelets from the spleen into to circulation upon rewarming may promote coagulation disturbances.

Wischnewski Spots and Black Oesophagus in Suspected Fatal Hypothermia in a Brown Howler Monkey (Alouatta guariba clamitans) and a Rabbit (Oryctolagus cuniculus)

Fatal hypothermia represents a diagnostic challenge in veterinary pathology. Wischnewski spots (WS) and black oesophagus (BO) have been described in human cases of fatal hypothermia but rarely in animals. We now describe WS and BO in suspected fatal hypothermia in a free-ranging brown howler monkey (Alouatta guariba clamitans) and a pet rabbit (Oryctolagus cuniculus). Both animals had dark spots resembling WS on the gastric mucosa and the monkey also had BO with haematin deposition. In both cases, stress factors and relatively cold environmental conditions were present prior to death.

Renal Tubular Epithelial Subnuclear Vacuolization in Hypothermia and Diabetic Ketoacidosis-A Retrospective Autopsy Study.

Subnuclear vacuolization of the renal tubular epithelium refers to discrete lipid vacuoles displacing the nuclei toward the lumen. This phenomenon has been associated with conditions sharing fatal ketoacidosis as a common denominator. This retrospective study aimed to investigate renal tubular epithelial subnuclear vacuolization and other postmortem examination findings in fatal hypothermia and diabetic ketoacidosis (DKA) cases.Fourteen cases with hypothermia and 19 cases with DKA were included. More cases with DKA had focal or diffuse subnuclear vacuolization compared with hypothermia cases (89% vs 43%; P = 0.007). In 6 cases with DKA, formalin pigment was detected within subnuclear vacuoles, whereas no case with hypothermia had formalin pigment deposition. Comparative analyses of hypothermia and DKA cases revealed further differences: Vitreous beta-hydroxybutyrate was higher in the DKA group compared with the hypothermia group (P = 0.044), whereas blood ethanol concentrations were higher in the latter (P = 0.008). Hypothermia cases were older compared with the DKA cases (P = 0.022).When all cases were included in the statistical analysis, cases with subnuclear vacuolization had higher vitreous beta-hydroxybutyrate and blood ethanol concentrations (P = 0.029 and 0.023, respectively). The findings corroborate the results of previous studies suggesting a link between subnuclear vacuolization and increased levels of ketoacidosis.

NIV sırasında Uzun Süreli Deksmedetomidin Kullanımının Yaşa Bağlı Hemodinamik Etkileri

Objective: Sedation in the intensive care unit plays a key role in patient management as it helps suppress agitation, increases tolerance to stress, and facilitates medical interventions, such as noninvasive ventilation (NIV) Our purpose was to determine the long-term hemodynamic effects of dexmedetomidine in elderly patients with acute respiratory failure who require NIV. Methods: We recorded the data concerning age, comorbidities, doses of dexmedetomidine, hemodynamic parameters, use of vasopressors and length of ICU stay, from the hospital electronic medical recor system Due to the possibility of causing hemodynamic instability in ICU, patients with reduced ventricular contractility, hypothermia, septic shock, endocrine pathologies and neurosurgery cases, were excluded from the study. Results: The patients were evaluated in four age groups: Group I: 18-39 years; Group II, 40-64 years; Group III, 65-80 years, and Group IV, aged &gt;80 years The patients in group IV were found to be at a higher risk for a decrease in MAP following onset of dexmedetomidine treatment (p=0.005*). Notably, most of the vasoactive agents were used in patients over 85 years old (54.2%, p=0.005). With increasing age hypotension and vasopressor needs were found to exhibit a corresponding augmentation. Conclusion: Dexmedetomidine meets requirements for sedation during NIV in the ICU. Even without loading dose the drug can induce hemodynamic instability, therefore close monitoring is necessary. In elderly, dexmedetomidine should be started at the lowest possible dose and slowly titrated according to the patient’s response.

A Case Study of Prazosin-Induced Hypothermia

A case report of prazosin-induced hypothermia in a treatment-naive patient with PTSD. A 65-year-old woman with bipolar disorder and nightmares resulting from previous traumas was admitted to an inpatient psychiatry unit for mixed state hypomania and depression with suicidal ideation. Prazosin 1mg was started to help manage nightmares and the patient developed asymptomatic hypothermia with a low of 33.5C after 5 days of therapy. After internal medicine and endocrinology consults and appropriate testing did not result in an explanation, prazosin was stopped and her temperature returned to normal. A rechallenge of prazosin again resulted in a temperature decrease and was then discontinued. Hypothermia is not a reported side effect of prazosin in humans, though one previous case study reports hypothermia with a 20mg total daily dose in the treatment of a patient with hypertension. Animal studies indicate two possible mechanisms of action including 1) increased heat dissipation from skin by inhibition of non-shivering thermogenesis and decreased metabolic rate and 2) temperature increases upon rapid eye movement sleep deprivation (REMSD) in rats by increasing noradrenaline. Prazosin modulates REMSD-induced changes in body temperature in rats by blocking the effects of noradrenaline in postsynaptic receptors. To our knowledge, this is only the second reported case of hypothermia induced by prazosin.

Combined effect of cold with heart pathology in old

Death due to hypothermia is because of exposure to cold temperature, usually during winter season and at high altitudes. Hypothermia occurs when the core body temperature drops below 35°C. Diagnosing hypothermia as the cause of death is very challenging in forensic medicine as the post-mortem findings are not consistent for all hypothermia cases. Therefore, history of the case and investigation of circumstances of the death, crime scene along with a meticulous post-mortem examination is very important in diagnosing cause of death as due to hypothermia. Paradoxical undressing and hide and die syndrome can sometime make the crime scene very suspicious. Hypothermia mainly affects homeless individuals, drug-dependent individuals and those of extreme ends of the age spectrum but can occur in any age group. Hypothermia is relatively rare in places like India with temperate climates as compared to places with colder climate. Hence, there is lack of knowledge about such a condition among both the medical professionals and the common people. Here we report a case of hypothermia in an 82 year old male who was found dead, half naked during the cold winter season and when stomach was opened, Wischnewsky spots were observed on the mucosa.

経皮的心肺補助装置が有用だった偶発性低体温症による心肺停止の1例(A case of cardiopulmonary arrest due to accidental hypothermia that was treated effectively with extracorporeal membrane oxygenation)

要旨 偶発性低体温症による心肺停止の蘇生と体温管理に，veno–arterial extracorporeal membrane oxygenation （V–A ECMO）が有用だった症例を経験したので報告する。症例は73歳の女性。3月某日の昼前，側溝にはまっているところを発見され，救急要請となった。初期波形は心静止で，搬送中に心室細動となった。電気的除細動に抵抗性で，病院到着後も一貫して心室細動が持続した。膀胱温は23.3℃で，偶発性低体温症による難治性心室細動と考え，V–A ECMOを用いて心肺蘇生と復温を行う方針とした。救急隊接触から69分後にV–A ECMOを駆動開始し，救急隊接触から206分後に膀胱温が32℃に達したため，電気的除細動を行ったところ，心拍再開した。引き続き体温管理療法を行い，膀胱温34℃を24時間維持した。入院2日目にV–A ECMOは離脱できた。頭部CTでは散在性の脳梗塞を合併したものの，入院8日目には簡単な意思疎通が可能になり，入院9日目には意識レベルは清明まで改善した。心停止時間は最低206分間と長時間であったが，高度の低体温では神経学的予後が期待できる可能性があるので，心停止時間が長くとも，V–A ECMOを用いた管理を検討するべきである。

The relationship between knowledge and hypothermia first aid attitudes in mountain climbers

Mountain climbing is an interesting and challenging activity, but it has high risks. There is a risk of harm that threat the body and safety during mountain climbing. One of the risks that can occur in mountain climbing is hypothermia which should be treated quickly and appropriately otherwise it can be life-threatening. From the results of preliminary studies that have been conducted by researchers at the Mount Prau Basecamp. According to the Gunung Prau Basecamp guard in 2017 there were 4 cases of hypothermia per week, even in 2014 there was 1 case of a climber who died due to hypothermia. This case occurred because of the climber's lack of knowledge of doing first aid to victims who had hypothermia. In this case, the climber's knowledge and attitude about prevention and first aid when experiencing hypothermia are the most important factors.The aim of this study was to determine the correlation between climber's knowledge and hypothermia first aid attitudes on the mountain.The type of this research was quantitative research with the correlation study method and a cross-section approach. The population in this study were all climbers of Mount Prau Wonosobo with a sample of 333 respondents. The sampling technique used in this study was consecutive sampling. The data in this study were analyzed using the chi square statistical test.The results of this study were obtained from 333 respondents, 301 respondents (90.4%) had good knowledge and 297 respondents (89.2%) had good attitudes. Statistical analysis showed significant results with a p-value (0.0001) less than 0.05, thus H0 was rejected and H1 was accepted, which indicated that there was a relationship between the climber's knowledge and hypothermia first aid attitudes on the mountain. In conclusion Knowledge affects a person's attitude towards handling hypothermia. On condition that the knowledge is good, ensuingly the attitude in handling hypothermia will be good.

Subnuclear Lipid-Containing Vacuolization in Cases of Ketoacidosis - Correlation of Morphological Findings and Ketone Body Concentrations

In a study on alcoholics, diabetics, cases of hypothermia, combinations of alcoholism, diabetes and hypothermia as well as 55 controls, ketone body measurements were performed in femoral vein blood, heart blood, vitreous humor, cerebrospinal fluid and urine. Histological investigations were carried out on the kidneys of the deceased. In addition to HE-staining, the cuts were stained with Sudan and PAS to allow differentiation between lipids and glycogens. The degree of stainability in the Sudan stains was correlated with the ketone body concentrations measured. In those cases in which elevated ketone body concentrations were measured, marked fat deposits in the renal tubular epithelial cells could be demonstrated with the Sudan staining method. The higher the stainability the higher the ketone body concentrations. The ketone body concentrations measured in the various body fluids correlated with the intensity of fat stainability.

Successful Resuscitation of the Longest Reported Case of Severe Hypothermia Complicated by Cardiac Arrest

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ANTIPSYCHOTIC MEDICATION EFFECTS MIMICKING MYXEDEMA COMA AND SEPSIS

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Olanzapine (Zyprexa) is an atypical antipsychotic that affects the dopaminergic pathway and is commonly used in the treatment of schizophrenia and bipolar disorder. Common side effects include extrapyramidal syndrome, akathisia, hyperprolactinemia, weight gain, and transaminitis. Rare adverse effects include hypothermia, bradycardia, and hemodynamic instability, while neutropenia is even more rare. CASE PRESENTATION: A 64-year-old woman with history of schizophrenia was brought in from jail for bilateral lower extremity edema and hypothermia unrelated to environmental exposure. On arrival, she was agitated, hypotensive (MAP <60), bradycardic (HR in 50s), and hypothermic with a rectal temperature of 90.4°F. Due to the patient’s psychotic state, no history could be elicited. Initial differential diagnoses included myxedema coma and sepsis. Fluid bolus, antibiotics, intravenous levothyroxine and hydrocortisone were immediately administered. Laboratory findings were significant for neutropenia with an absolute neutrophil count of 984, which was previously normal three weeks earlier. Peripheral smear demonstrated few large granular lymphocytes, which are normal variants. Thyroid studies showed a normal free T4 and mildly elevated TSH with a value of 6.45 mcIU/mL (0.34 – 5.60 mcIU/ml), consistent with subclinical hypothyroidism. Additional findings included a normal lactate, clear urinalysis, unremarkable chest x-ray, and pan-CT non-revealing for an infectious source. Patient did have bilateral lower extremity erythema and edema concerning for bilateral lower extremity cellulitis, but this was not significant enough to account for her severe hypothermia, bradycardia, and hemodynamic instability. On further investigation, the only medication the patient was taking at the time of presentation was olanzapine, a court-ordered medication for her psychotic symptoms, which was started thirteen days prior to symptoms. During her hospital stay, olanzapine was stopped and switched to aripiprazole (Abilify), which was tolerated well by the patient in the past. Additionally, with active warming and supportive care with fluids and antibiotics, the patient’s clinical condition improved. Neutropenia resolved five days after olanzapine was discontinued, and all culture data returned without any sign of infection. DISCUSSION: This case illustrates how rare adverse reactions from an antipsychotic medication can confound the clinical picture and mimic another diagnosis, specifically myxedema coma and sepsis. There have been less than a hundred reported cases of antipsychotic-related hypothermia and only two reported cases of olanzapine-related neutropenia in the literature. CONCLUSIONS: Awareness of these rare adverse reactions, alongside a thorough investigation and open-minded differential were critical in deciphering this intriguing case. Reference #1: Malhotra K et al. Olanzapine-induced neutropenia. Ment Ill (2015) 7(1):5871. Reference #2: Zonnenberg C et al. Hypothermia due to antipsychotic medication: a systematic review. Front Psychiatry (2017) 8:165. DISCLOSURES: No relevant relationships by Liwayway Andrade, source=Web Response No relevant relationships by Chukwufumnanya Ikeneme, source=Web Response No relevant relationships by Jaison John, source=Web Response No relevant relationships by Nisha Soneji, source=Web Response

Embrace versus Cloth Wrap in preventing neonatal hypothermia during transport: a randomized trial.

We assessed the efficacy of Embrace Nest Infant Warmer versus Cloth Wrap in preventing hypothermia during short-term transport from the emergency department (ED) to the neonatal intensive care unit (NICU). Neonates weighing ≥1500 g coming to the ED were randomized for transport to the NICU. Axillary temperature was measured. A total of 120 newborns (60 per group) were enrolled. From ED exit to NICU entry, the mean (SD) temperature increased in the Embrace group by 0.37 °C (0.54), whereas it reduced by 0.38 °C (0.80) in the Cloth group (p < 0.001). Hypothermia cases reduced in the Embrace group from 39 (65%) to 21 (35%), while it increased from 21 (35%) to 39 (65%) in the Cloth group (p = 0.001) from ED exit to NICU entry. The thermoregulation for 24 h after admission to the NICU was superior in the Embrace group. Embrace showed significantly better thermoregulation in neonates. Further studies should be done to measure its effectiveness in different environments and distances.

Perinatal quality improvement bundle to decrease hypothermia in extremely low birthweight infants with birth weight less than 1000 g: single-center experience over 6 years

Normothermia (36.5°C–37. 5°C) at the time of admission to the neonatal intensive care unit (NICU) in extremely low birthweight (ELBW) infants (birth weight <1000 g) is associated with decreased morbidity...

A case report of acute hypothermia during initial inpatient clozapine titration with review of current literature on clozapine-induced temperature dysregulations

BackgroundHere we describe a unique case of clozapine-associated hypothermia during initial titration of this medication in an acute inpatient psychiatry setting. Only a handful of cases on this topic have been published. We discuss possible pharmacologic mechanisms supporting or refuting the propensity of clozapine to induce hypothermia, as well as risk factors for clozapine-induced hypothermia, and a comparison to clozapine-induced hyperthermia.Case presentationA 70 year-old African American female with treatment-refractory schizoaffective disorder developed hypothermia with a nadir temperature of 89 °F (31.7 °C) after 7 days on clozapine, on a total dose of 50 mg twice daily. Accompanying symptoms included bradycardia, hypotension, QTc prolongation, tachypnea, hypoxemia, and an absence of shivering. The patient was transferred to the ICU, and rewarmed within 10 h with the discontinuation of her clozapine, ziprasidone, and carvedilol. Broad spectrum antibiotics were initiated, but discontinued shortly after, as the patient had no leukocytosis, and blood cultures were negative.DiscussionWhile hypoglycemia, hypothyroidism, sepsis, and stroke were effectively ruled out, alternative drug-disease (including chronic kidney disease), and drug-drug interactions were considered possible contributing features. Benzodiazepines, valproic acid, ziprasidone, and the numerous antihypertensive agents the patient was taking were considered as either primary or compounding factors for hypothermia. After exclusion or inclusion of these alternative causes, we calculated a score of 4 (possible) for clozapine-induced hypothermia on the Naranjo Scale.ConclusionsClozapine-induced hypothermia may occur more commonly than clinicians believe. Practitioners should be cognizant of this potentially fatal phenomenon, and monitor for temperature dysregulations while on clozapine, especially during initial titration, in those with multiple comorbid factors, and on additional medications that may contribute to hypothermia.

Cortisol levels after cold exposure are independent of adrenocorticotropic hormone stimulation.

We previously showed that postmortem serum levels of adrenocorticotropic hormone (ACTH) were significantly higher in cases of hypothermia (cold exposure) than other causes of death. This study examined how the human hypothalamic-pituitary-adrenal axis, and specifically cortisol, responds to hypothermia. Human samples: Autopsies on 205 subjects (147 men and 58 women; age 15–98 years, median 60 years) were performed within 3 days of death. Cause of death was classified as either hypothermia (cold exposure, n = 14) or non-cold exposure (controls; n = 191). Cortisol levels were determined in blood samples obtained from the left and right cardiac chambers and common iliac veins using a chemiluminescent enzyme immunoassay. Adrenal gland tissues samples were stained for cortisol using a rabbit anti-human polyclonal antibody. Cell culture: AtT20, a mouse ACTH secretory cell line, and Y-1, a corticosterone secretory cell line derived from a mouse adrenal tumor, were analyzed in mono-and co-culture, and times courses of ACTH (in AtT20) and corticosterone (in Y-1) secretion were assessed after low temperature exposure mimicking hypothermia and compared with data for samples collected postmortem for other cases of death. However, no correlation between ACTH concentration and cortisol levels was observed in hypothermia cases. Immunohistologic analyses of samples from hypothermia cases showed that cortisol staining was localized primarily to the nucleus rather than the cytoplasm of cells in the zona fasciculata of the adrenal gland. During both mono-culture and co-culture, AtT20 cells secreted high levels of ACTH after 10–15 minutes of cold exposure, whereas corticosterone secretion by Y-1 cells increased slowly during the first 15–20 minutes of cold exposure. Similar to autopsy results, no correlation was detected between ACTH levels and corticosterone secretion, either in mono-culture or co-culture experiments. These results suggested that ACTH-independent cortisol secretion may function as a stress response during cold exposure.

Low myocardial transcript variant alt-a of cyclin dependent kinase inhibitor p21 expression differentiates hypothermia from cardiac/respiratory causes of death.

Gene expressions in the myocardium have been shown to vary between different causes of death, which can be utilized in the recognition of varied processes. Our previous work with a limited number of cases showed a high messenger ribonucleic acid expression of the transcript variant alt-a of cyclin dependent kinase inhibitor p21 (p21 alt-a) in chronic cardiac ischemia deaths and a low expression in hypothermia deaths and acute myocardial ischemia deaths. In present work, p21 alt-a expression in the myocardium of human cadavers was calculated using glyceraldehyde-3-phosphate dehydrogenase (GAPDH) as reference gene. In this collection of 143 samples, the p21 alt-a expression was significantly lower in hypothermia than in chronic cardiac ischemic heart disease with (P < .001) or without (P < .001) acute myocardial infarction and in other cardiac and respiratory disease deaths (P < .000). Chronic ischemic heart disease in hypothermia cases did not increase the expression. The p21 alt-a expression did not correlate with postmortem interval, quality of RNA or with the age of the deceased. The p21 alt-a referenced to GAPDH expression in cadaver myocardium has apparent potential as a marker distinguishing between hypothermia and cardiac/respiratory diseases as causes of death.

An unusual case of hypothermia and paradoxical undressing in Western Sydney

An unusual case of hypothermia and paradoxical undressing in Western Sydney