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Hypothermia: Causes, Symptoms & Treatment

Hypothermia is a life-threatening condition in which the core body temperature drops below 35 °C (95 °F). Prompt rewarming and medical care are essential for survival.

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Things worth knowing about "Hypothermia"

Hypothermia is a life-threatening condition in which the core body temperature drops below 35 °C (95 °F). Prompt rewarming and medical care are essential for survival.

What is Hypothermia?

Hypothermia is a medical emergency that occurs when the body loses heat faster than it can produce it, causing the core body temperature to fall below 35 °C (95 °F). The human body requires a stable core temperature of approximately 37 °C (98.6 °F) to maintain vital organ function. A significant drop in core temperature can severely impair the heart, brain, and other organs.

Causes

Hypothermia occurs when heat loss exceeds heat production. Common causes include:

Prolonged exposure to cold air, wind, or rain
Immersion in cold water (near-drowning, shipwrecks)
Inadequate clothing in low temperatures
Extremes of age (elderly individuals, newborns)
Alcohol or drug use, which impairs the body's thermoregulation
Underlying conditions such as hypothyroidism, diabetes, or malnutrition
Homelessness and sleeping outdoors

Severity Classification

Hypothermia is classified into degrees based on core body temperature:

Mild hypothermia (32–35 °C / 90–95 °F): Shivering, confusion, increased heart rate and respiratory rate
Moderate hypothermia (28–32 °C / 82–90 °F): Cessation of shivering, muscle rigidity, impaired consciousness, slowed heartbeat
Severe hypothermia (below 28 °C / 82 °F): Loss of consciousness, irregular heart rhythm (ventricular fibrillation), respiratory arrest, life-threatening danger

Symptoms

Symptoms of hypothermia develop progressively and depend on the severity:

Intense shivering (early sign)
Pale or bluish skin (cyanosis)
Slurred speech and slowed reactions
Confusion and disorientation
Loss of coordination and stumbling
Fatigue and apathy
In advanced stages: loss of consciousness and cardiac arrest

Diagnosis

Diagnosis is confirmed by measuring the core body temperature. Standard fever thermometers are not suitable, as they do not register temperatures below 35 °C. In clinical settings, rectal, esophageal, or bladder temperature measurements are used. Additional tests such as an ECG, blood count, and electrolyte levels provide further diagnostic information.

Treatment

First aid for hypothermia includes the following steps:

Remove the person from the cold environment and prevent further heat loss
Carefully remove wet clothing and wrap the person in warm blankets
Keep the person in a horizontal position to support circulation
Avoid vigorous rubbing or massaging of limbs (risk of triggering cardiac arrhythmias)
If unconscious: place in recovery position or begin cardiopulmonary resuscitation (CPR)
Call emergency services immediately (e.g. 911 or local emergency number)

In-hospital rewarming depends on severity:

Passive rewarming: Warm environment, insulating blankets (mild cases)
Active external rewarming: Warming blankets, heated intravenous fluids
Active internal rewarming: Warmed humidified oxygen, bladder irrigation, or in severe cases extracorporeal circulation (ECMO)

Therapeutic Hypothermia

Hypothermia also has a controlled medical application. Therapeutic hypothermia (also known as Targeted Temperature Management, TTM) involves deliberately lowering the core body temperature to 32–36 °C after cardiac arrest or severe traumatic brain injury to protect the brain from secondary damage.

Prevention

Hypothermia can be prevented through simple precautions:

Wear weather-appropriate, layered clothing
Avoid alcohol in cold environments
Carry adequate food, water, and emergency equipment during outdoor activities
Regularly check on vulnerable individuals (elderly, infants)
Change out of wet clothing promptly

References

Paal, P. et al. (2022): Accidental Hypothermia - An Update. International Journal of Environmental Research and Public Health, 19(1), 501. DOI: 10.3390/ijerph19010501
Zafren, K. & Danzl, D. F. (2019): Hypothermia. In: Tintinalli's Emergency Medicine, 9th ed. McGraw-Hill Education.
European Resuscitation Council (ERC) Guidelines 2021: Special Circumstances - Hypothermia. Available at: https://www.erc.edu

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