Accidental hypothermia

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Evidence last reviewed: 13 Apr 2026

Topic last updated: 27 Mar 2026

Accidental hypothermia is defined by the unintentional lowering of core body temperature to <95°F (<35°C).

Classified as mild, moderate, or severe according to core temperature. Some experts have suggested a further (more severe) category of profound hypothermia, at a core temperature <75.2°F (<24°C) according to some and <68°F (<20°C) according to others.

Core temperature measured in the lower third of the esophagus correlates well with pulmonary artery temperature and is preferred in patients with a secure airway.

Initial management should focus on stopping further cooling, resuscitation, and supportive care. This includes removing the patient from the cold environment, careful removal of wet or cold clothing, insulation, warming the body, securing the airway, monitoring breathing and circulation, and maintaining circulation using warm intravenous fluids.

Choice of rewarming strategy (passive external, active external, active internal/core) is based on the patient’s core temperature and clinical features; a combination of techniques may be used.

Patients who have sustained a hypothermic cardiac arrest should ideally be rewarmed in a specialist center using extracorporeal life support.

定义

Accidental hypothermia is characterized by the unintentional lowering of core body temperature to <95°F (<35°C).[1]

A threshold of 96.8°F (36°C) has been adopted in patients with trauma given that hypothermia is associated with higher mortality in this patient group.[2][3]

This topic covers accidental hypothermia in adults.

病史和体格检查

关键诊断因素

cold exposure and body temperature <95°F (<35°C)
impaired mental status
shivering
frostbite

完整详情

其他诊断因素

tachypnea, tachycardia, hypertension
respiratory depression, bradycardia, hypotension
coma and apnea
cold-induced diuresis

完整详情

危险因素

trauma
drowning
general anesthetic use
substance misuse
impaired cognition
hypothyroidism
stroke
Parkinson disease
homelessness
extremes of age
gram-negative septicemia
immobility
use of certain drugs

完整详情

诊断性检查

首要检查

core temperature measurement
12-lead ECG
CBC
serum electrolytes
blood glucose
ABG
clotting screen
chest x-ray

完整详情

需考虑的检查

serum creatinine kinase
myoglobin levels
end-tidal CO₂
ultrasound

完整详情

治疗流程

急症处理

mild hypothermia: >90°F to 95°F (>32°C to 35°C)

moderate or severe hypothermia not in cardiac arrest: ≤90°F (≤32°C)

moderate or severe hypothermia in cardiac arrest: ≤90°F (≤32°C)

撰稿人

专家顾问

Emmanuel Atta Agaba, MD, FRCSEd, FACS

Attending Surgeon

Assistant Professor of Surgery

Montefiore Medical Center at Albert Einstein College of Medicine

Bronx, NY

利益声明

EAA declares that he has no competing interests.

鸣谢

Dr Emmanuel Agaba would like to gratefully acknowledge Dr Rafael Barrera and Dr Juan Jose Gilbert, previous contributors to this topic.

利益声明

RB and JJG declare that they have no competing interests.

同行评议者

Wail Malaty, MD

Clinical Professor

Department of Family Medicine

University of North Carolina

Chapel Hill

Assistant Program Director

MAHEC Rural Family Medicine Residency

Hendersonville, NC

利益声明

WM declares that he has no competing interests.

James S. Milledge, MBBS

Honorary Professor

Department of Physiology

University College London

London

利益声明

JSM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Paal P, Pasquier M, Darocha T, et al. Accidental hypothermia: 2021 update. Int J Environ Res Public Health. 2022 Jan 3;19(1):501.全文摘要

Lott C, Karageorgos V, Abelairas-Gomez C, et al. European Resuscitation Council guidelines 2025 special circumstances in resuscitation. Resuscitation. 2025 Oct;215 Suppl 1:110753.全文摘要

Cao D, Arens AM, Chow SL, et al. Part 10: adult and pediatric special circumstances of resuscitation: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2025 Oct 21;152(16_suppl_2):S578-672.全文摘要

Dow J, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Society clinical practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2019 update. Wilderness Environ Med. 2019 Dec;30(4 Suppl):S47-69.全文摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断
- Sepsis
- Hypothyroidism
- Hypoglycemia
更多鉴别诊断
指南
- 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care: part 10: adult and pediatric special circumstances of resuscitation
- European Resuscitation Council guidelines 2025 special circumstances in resuscitation
更多指南
医学计算器
Hypothermia outcome prediction after ECLS (HOPE) score
更多医学计算器
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Accidental hypothermia

Summary

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

治疗流程

mild hypothermia: >90°F to 95°F (>32°C to 35°C)

moderate or severe hypothermia not in cardiac arrest: ≤90°F (≤32°C)

moderate or severe hypothermia in cardiac arrest: ≤90°F (≤32°C)

撰稿人

专家顾问

Emmanuel Atta Agaba, MD, FRCSEd, FACS

利益声明

鸣谢

利益声明

同行评议者

Wail Malaty, MD

利益声明

James S. Milledge, MBBS

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断

指南

医学计算器

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

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