Hypothermia in Child
Alerts and Notices
Synopsis
Children are at higher risk than adults for hypothermia as they are unlikely to recognize the symptoms of impending hypothermia and have limited ability to avoid or escape exposure. Furthermore, children have a greater surface area to body mass ratio, predisposing them to more rapid radiant heat loss and ensuring that they cannot as effectively raise their body temperatures through glycogen mobilization or shivering.
Hypothermia can be characterized as mild (35°C-32°C), moderate (32°C-28°C), or severe (below 28°C). Clinical manifestations of hypothermia vary according to severity.
In mild cases, presentation includes pallor, shivering, tachycardia, and tachypnea. Moderate cases can present with lethargy, hallucinations, paradoxical undressing, hypoventilation, and decreased shivering. Severe cases present with coma, hypotension, arrhythmias, apnea, and pseudo-rigor mortis. Laboratory derangements such as hyper- or hypoglycemia, thrombocytopenia, leukopenia, elevated creatine phosphokinase (CPK) secondary to rhabdomyolysis, and abnormal liver function tests may also be present in patients with moderate or severe hypothermia. Despite being at higher risk for severe hypothermia, children often have better neurologic outcomes in the setting of severe hypothermia compared to adults.
The key to management is timely diagnosis and initial support of the patient's airway, breathing, and circulation (ABC). Patients should be removed from the hypothermic environment, and rewarming should be initiated as soon as possible. Cardiopulmonary resuscitation should be started immediately in patients with cardiopulmonary arrest. Rewarming can take several hours with the goal body temperature of 32°C-35°C.
Codes
ICD10CM:T68.XXXA – Hypothermia, initial encounter
SNOMEDCT:
386689009 – Hypothermia
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Although exposure to cold environment is the most common cause of hypothermia, many medical conditions and medications can cause hypothermia due to autonomic dysregulation and inhibition of compensatory actions for lower temperatures.- Hypopituitarism
- Hypothyroidism
- Hypoglycemia
- Adrenal insufficiency
- Malnutrition
- Sepsis
- Venous insufficiency
- Neuromuscular diseases
- Medications or drugs of abuse
- Multiple sclerosis
- Spinal cord injuries
- Child abuse
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:10/15/2018
Last Updated:11/13/2018
Last Updated:11/13/2018
Hypothermia in Child