1. Hypothermia
By Clare Hunt, Nick Harper, Andrew
Whitehead
”Old and Cold”

2. Definition
a core temperature < 35°C
5% of acute admissions >65

3. Causes in the elderly
Environmental
•Falls/immobility
•Low room temp
•Malnutrition
Ageing process
•Decreased homeostatic
capacity
Acute Disease
•Pneumonia
•MI
•Heart Failiure
Chronic Disease
•Dementia – decreased cold
awareness
•Diabetic neuropathy

4. 32°C

5. Hypothermia Mimics
• hypo/hyperglycaemia
• cognitive decline
• cerebral vascular accident
• hypothyroidism
• myxoedema coma

6. Investigation
• Temperature!
• ECG (J waves?)
• URGENT bloods

7. Management
• Make patient comfortable
• Ventilate if necessary
• Beware decompensation
• Avoid provoking arrhythmias (eg NG tube)
• Warm IV fluids if <32°C

8. Warming
• SLOWLY! – 1/2°C/hour (ECG monitoring)
• Reheating too quickly can cause:
– Falling BP
– Peripheral vasodilatation
– Shock
– Death
• Rectal temp, BP, pulse + RR every ½ hr

9. Consider…
• Urinary catheter to assess renal function
• Abx for prevention of pneumonia
– all >65yrs with temp < 32°C
• Thiamine if alcohol abuse suspected
• Glucose

10. Complications
• Arrhythmias
• Pneumonia
• Pancreatitis
• Acute renal failure
• Intravascular coagulation

11. Prognosis
• Depends on:
1. Age
2. Degree of hypothermia
Mortality >50%
Age > 70
+
temp < 32°C

12. Before hospital discharge..
• Will this happen again?
• Support network?
• Review medication
• Liase with GP/ social worker

13. Summary
• Many potential causes in the elderly
• Consider in any elderly acute admission
• Poor prognosis if untreated
• Warm slowly