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Accidental hypothermia

Last reviewed: 3 Apr 2025
Last updated: 13 Feb 2025

Summary

Definition

History and exam

Key diagnostic factors

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

Other diagnostic factors

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

Risk factors

  • 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
Full details

Diagnostic tests

1st tests to order

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

Tests to consider

  • serum creatinine kinase
  • myoglobin levels
  • end-tidal CO₂
  • ultrasound
Full details

Treatment algorithm

ACUTE

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)

Contributors

Authors

Emmanuel Atta Agaba, MD, FRCSEd, FACS
Emmanuel Atta Agaba

Attending Surgeon

Assistant Professor of Surgery

Montefiore Medical Center at Albert Einstein College of Medicine

Bronx

NY

Disclosures

EAA declares that he has no competing interests.

Acknowledgements

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

Disclosures

RB and JJG declare that they have no competing interests.

Peer reviewers

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

Disclosures

WM declares that he has no competing interests.

James S. Milledge, MBBS

Honorary Professor

Department of Physiology

University College London

London

UK

Disclosures

JSM declares that he has no competing interests.

References

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Key articles

Paal P, Pasquier M, Darocha T, et al. Accidental hypothermia: 2021 update. Int J Environ Res Public Health. 2022;19(1):501.Full text  Abstract

Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021 Apr;161:152-219.Full text  Abstract

Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 Oct 20;142(16 Suppl 2):S366-468.Full text  Abstract

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.Full text  Abstract

Reference articles

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

    • Sepsis
    • Hypothyroidism
    • Hypoglycemia
    More Differentials
  • Guidelines

    • Clinical staging of accidental hypothermia: the revised Swiss system recommendation of the International Commission for Mountain Emergency Medicine (ICAR MedCom)
    • European Resuscitation Council guidelines 2021: cardiac arrest in special circumstances​
    More Guidelines
  • Calculators

    Hypothermia outcome prediction after ECLS (HOPE) score

    More Calculators
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