PDF(Pubmed)
Abstract：
Hypothermia is defined as a significant drop in core body temperature below 35°C (95°F). It is traditionally staged as mild, moderate, severe, and profound at temperatures of 35°C to 32°C (95°F to 89.6°F), 32°C to 28°C (89.6°F to 82.4°F), <28°C (<82.4°F), and <24°C (75.2°F), respectively. It can also be classified into the same stages by clinical presentations. We present a patient that fits into two different stages based on core body temperature and clinical presentation. A 58-year-old homeless male with a history of seizures and alcohol use presented via emergency medical services after spending the night outside and uncovered with a core body temperature of 25.1°C (77.1°F) via a urinary bladder thermometer, meeting criteria for severe, near profound, hypothermia. However, he was alert and communicating, shivering, with tachycardia, tachypnea, normal oxygen saturation, and elevated blood pressure, suggestive of mild hypothermia clinically. Passive and active external and internal rewarming were utilized to treat, with the removal of wet clothing, forced air patient warming system, warm blankets, and warm lactated ringers given intravenously. He was soon transferred to the intensive care unit and first returned to normothermic levels after approximately 10 hours from presentation. An electrocardiogram was obtained after resolution of shivering and revealed atrial fibrillation without Osborn waves. He remained in the hospital for the following week to treat his atrial fibrillation, hypothermia-induced rhabdomyolysis, and alcohol withdrawal. He was discharged without neurologic deficits and medically stable with appropriate resources. This case demonstrates a unique presentation of severe hypothermia. To our knowledge, there has not been a reported case of severe hypothermia that does not involve severe central nervous system depression, severe slowing of vitals, and/or comatose status. These clinical symptoms normally begin during moderate hypothermic levels near 32°C (89.6°F), yet our patient presented without any central nervous system depression and with accelerated vitals that are more consistent with mild hypothermia yet had a core temperature of 25.1°C (77.1°F). Treatment was dictated by his core body temperature rather than clinical presentation. Because of this incongruence between symptoms and true severity of disease in hypothermia, we recommend diagnosis and treatment of hypothermia always be confirmed and based on core body temperature via a low-reading thermometer instead of clinical presentation alone.
摘要：
体温过低定义为核心体温显著下降至35°C(95°F)以下。传统上它是温和的，中度,严重,在35°C至32°C（95°F至89.6°F）的温度下，32°C至28°C（89.6°F至82.4°F），<28°C(<82.4°F),和<24°C（75.2°F），分别。它也可以通过临床表现分为相同的阶段。我们介绍了根据核心体温和临床表现分为两个不同阶段的患者。一名58岁的无家可归的男性，有癫痫发作和饮酒史，在外面过夜后通过紧急医疗服务提供，并通过膀胱温度计发现核心体温为25.1°C（77.1°F），符合严重的标准，近深刻，体温过低.然而,他很警觉和沟通，颤抖,心动过速,呼吸急促,正常氧饱和度,血压升高,提示轻度低温临床。被动和主动的外部和内部复温被用来治疗，随着湿衣服的脱掉，强制空气加温系统，温暖的毯子，静脉给予温暖的乳酸林格。他很快被转移到重症监护病房，并在就诊约10小时后首次恢复到正常体温水平。颤抖消退后获得心电图，并显示无Osborn波的心房颤动。接下来的一周，他留在医院治疗他的心房颤动，低温诱导的横纹肌溶解症,酒精戒断。他出院时没有神经缺陷，并且在适当的资源下病情稳定。此病例显示了严重低温的独特表现。据我们所知,目前还没有报道一例严重的低温症，不涉及严重的中枢神经系统抑郁症，生命体征严重减慢,和/或昏迷状态。这些临床症状通常在32°C（89.6°F）附近的中度低温水平开始，然而,我们的患者表现为没有任何中枢神经系统抑制,并且具有更符合轻度低温的加速生命体征,但核心温度为25.1°C(77.1°F).治疗取决于他的核心体温而不是临床表现。由于这种症状与体温过低疾病的真实严重程度之间的不一致，我们建议始终通过低读数体温计来确认低体温的诊断和治疗，而不是仅根据临床表现。
