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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The development of hypothermia and coma are rare complications of the Wernicke-Korsakoff syndrome. This report describes three patients with Wernicke's encephalopathy in whom hypothermia was a presenting feature. The second patient described was also comatose. The frequency of occurrence and the significance of these signs are reviewed in detail, as is their potential reversibility with adequate doses of parenteral thiamine. More careful attention to the rectal temperature in patients with Wernicke's encephalopathy may reveal a higher frequency of hypothermia than has been previously suspected.
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PMID:Hypothermia and coma in the Wernicke-Korsakoff syndrome. 720 47

Of 59 adults admitted to Bellevue Hospital, New York, between 1968 and 1979 because of hypothermia due to exposure, 24 (41%) had 32 serious infections. Nine infections were not diagnosed at the time of admission. Infected patients warmed to higher peak temperatures were more likely to be comatose and had lower lymphocyte counts. At admission, physicians gave antibiotics to only one of nine patients with occult infection but to ten of 35 uninfected patients, thus failing to identify which patients required prompt antibiotic therapy. Delay in therapy contributed to the death of two patients. Since infection is frequently masked in hypothermic patients, careful repeated evaluations should be carried out to identify early infections. Although the proper use of antibiotics in patients with hypothermia is unresolved, we believe that prompt empiric antibiotic therapy is appropriate.
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PMID:Infections in hypothermic patients. 723 12

From 1975 to 1978, ten patients were on long-term hemodialysis due to acute barbiturate intoxication. Duration of hemodialysis varied from 16 to 40 hours (mean 23 +/- 9.4 hours). Phenobarbital was the most common type of barbiturate ingested (6 out of 10 patients), and diazepam the drug most frequently taken in association with barbiturates (3 out of 10 patients). All patients were in a state of deep unconsciousness (coma II: 1 case; coma III: 5 cases; coma IV: 4 cases), and all of them required endotracheal intubation. Seven patients needed the assistance of automatic intermittent positive-pressure respirator. Two patients presented hypothermia, and another a peripheral collapse. Long-term hemodialysis was well tolerated without major complications. Significant decreases of barbiturate levels were obtained in all cases (before hemodialysis: 7.3 +/- 1.9 mg/dl, after hemodialysis: 1.8 +/- 1.2 md/dl, corresponding to the pattern of secobarbital used to refer the results). No correlation was observed between initial levels of barbiturates and number of hours of long-term hemodialysis required. Neurologic symptoms improved in all cases. Eight patients were conscious after hemodialysis had been discontinued, and only two patients remained unconscious (coma I). Intratracheal tube could be removed in six patients, but positive-pressure respirator could be took away from all cases. Complete recovery was achieved in eight patients. Two patients died on the 2nd. and 8th. postdialysis days due to respiratory distress. Long-term hemodialysis has proven of value in the treatment of severe barbiturate intoxication, particularly better to conventional hemodialysis.
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PMID:[Long-term hemodialysis in acute barbiturate intoxication (author's transl)]. 740 33

Accidental hypothermia has a mortality rate of 30-80% and should always be borne in mind with comatose, hypotensive patients. It is a preventable condition when adequate safety measures are ensured. One should act in the case of early symptoms, because collapse may soon follow and evacuation of a patient on a stretcher is time-consuming, dangerous and a major undertaking. In severe cases absence of respiration and circulation should not preclude resuscitation. Resuscitation should be continued until the patient is warm and all biochemical abnormalities have been corrected and intoxication has been ruled out. Resuscitation may be successful in primitive, adverse conditions, as illustrated by this case of a 13-year-old boy with cardiopulmonary arrest and a core temperature of only 25 degrees C, who was successfully reanimated.
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PMID:Successful resuscitation in severe accidental hypothermia: a case report. 740 88

Though the same symptoms are observed in either hyper- or hypothermia, the etiology may be of four different types: 1) the thermoregulatory mechanisms may be insufficient to adapt to temperature extremes in normal subjects; 2) there may be modifications in peripheral thermoregulatory responses, when the patient compensates for the deficiency or excess by other thermoregulatory responses: the internal temperature is then not distrubed but is not stable; 3) a central lesion causing loss of ability to oppose low temperatures results in hypothermia with coma as soon as the subject is exposed to cold. Loss of ability to oppose heat is not encountered: it is superimposable on the hyperexcitation of the centers that oppose heat; 4) modifications in thermoregulatory responses are mainly evident as fever, a protective defense reaction of the organism wich should be supported rather than fought. The inverse syndrome, if it exists, is difficult to distinguish from the loss of ability to oppose cold. The term of "anapyrexia" is suggested for this latter condition. Whatever the diagnosis, measurment of rectal temperature is insufficient for diagnosis, and thermoregulatory responses have to be evaluated. Therapy for the same symptom may, in fact, be inversed depending on the etiology. It may well be that thermoregulatory function is poorly understood because of its true importance. Possessing no specific organs, it uses the various reactions that have appeared during phytogenetic development to ensure thermal homeostasis. It acts permanently through multiple, independent, regulatory loops allowing many compensatory mechanisms. This underlines, in an indirect manner, the need for the organism to maintain at all costs a constant temperature. This permanent thermal homeostasis implies that only severe disorders result in hyper- or hypothermia, that major disturbances are rapidly fatal, which emphasizes the fundamental importance of thermorgulation.
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PMID:[Pathology of thermoregulation]. 742 83

Diagnosis of brain death must be certain to allow discontinuation of artificial ventilation and organ transplantation. Brain death is present when all functions of the brain stem have irreversibly ceased. Clinical and electrophysiological criteria may be misinterpreted due to drug intoxication, hypothermia or technical artefacts. Thus, if clinical assessment is suboptimal, reliable early confirmatory tests may be required for demonstrating absence of intracranial blood flow. We have easily carried out and interpreted 99mTc HM-PAO SPECT in a consecutive series of 40 comatose patients with brain damage, without discontinuing therapy. Brain death was diagnosed in 7 patients, by recognising absence of brain perfusion, as shown by no intracranial radionuclide uptake. In patients in whom perfusion was seen on brain scans, HM-PAO SPECT improved assessment of the extent of injury, which in general was larger than suggested by CT.
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PMID:99mTc HM-PAO brain perfusion SPECT in brain death. 747 35

Early results using cerebral perfusion pressure (CPP) management techniques in persons with traumatic brain injury indicate that treatment directed at CPP is superior to traditional techniques focused on intracranial pressure (ICP) management. The authors have continued to refine management techniques directed at CPP maintenance. One hundred fifty-eight patients with Glasgow Coma Scale (GCS) scores of 7 or lower were managed using vascular volume expansion, cerebrospinal fluid drainage via ventriculostomy, systemic vasopressors (phenylephrine or norepinephrine), and mannitol to maintain a minimum CPP of at least 70 mm Hg. Detailed outcomes and follow-up data bases were maintained. Barbiturates, hyperventilation, and hypothermia were not used. Cerebral perfusion pressure averaged 83 +/- 14 mm Hg; ICP averaged 27 +/- 12 mm Hg; and mean systemic arterial blood pressure averaged 109 +/- 14 mm Hg. Cerebrospinal fluid drainage averaged 100 +/- 98 cc per day. Intake (6040 +/- 4150 cc per day) was carefully titrated to output (5460 +/- 4000 cc per day); mannitol averaged 188 +/- 247 g per day. Approximately 40% of these patients required vasopressor support. Patients requiring vasopressor support had lower GCS scores than those not requiring vasopressors (4.7 +/- 1.3 vs. 5.4 +/- 1.2, respectively). Patients with vasopressor support required larger amounts of mannitol, and their admission ICP was 28.7 +/- 20.7 versus 17.5 +/- 8.6 mm Hg for the nonvasopressor group. Although the death rate in the former group was higher, the outcome quality of the survivors was the same (Glasgow Outcome Scale scores 4.3 +/- 0.9 vs. 4.5 +/- 0.7). Surgical mass lesion patients had outcomes equal to those of the closed head-injury group. Mortality ranged from 52% of patients with a GCS score of 3 to 12% of those with a GCS score of 7; overall mortality was 29% across GCS categories. Favorable outcomes ranged from 35% of patients with a GCS score of 3 to 75% of those with a GCS score of 7. Only 2% of the patients in the series remained vegatative and if patients survived, the likelihood of their having a favorable recovery was approximately 80%. These results are significantly better than other reported series across GCS categories in comparisons of death rates, survival versus dead or vegetative, or favorable versus nonfavorable outcome classifications (Mantel-Haenszel chi 2, p < 0.001). Better management could have improved outcome in as many as 35% to 50% of the deaths.
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PMID:Cerebral perfusion pressure: management protocol and clinical results. 875 77

A six-year-old girl with non-Hodgkin's lymphoma who was treated with both intravenous (IV) and intrathecal (IT) methotrexate and developed brain damage secondary to the cytostatic drug is described. This patient displayed hypertension, hypothermia/hyperthermia, lethargy, deterioration and coma as clinical findings, and bilateral, focal white matter hyperintensities in the occipital lobes were seen in her magnetic resonance imaging (MRI). Treatment-related leukoencephalopathy is one such adverse effect of IT methotrexate administration on the central nervous system and usually appears in a generalized form.
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PMID:Methotrexate-induced leukoencephalopathy. A case report. 750 68

Accidental hypothermia, a condition seldomly seen in Chile, is defined as a spontaneous core temperature reduction to less than 35 degrees C and is associated with great morbidity and mortality. We report a 16 years old female intoxicated with liquefied petroleum gas that was admitted in coma, hypothermic, with severe hemodynamic derangement, lactic acidosis, rhabdomyolysis and iliofemoral phlebothrombosis. Peritoneal dialysis with solutions at 27 degrees C was used as a quick and safe means to revert hypothermia and avoid its complications.
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PMID:[Hypothermia: a non renal indication for peritoneal dialysis]. 773 31

Coma and vomiting are the commonest symptoms in young teenagers intoxicated by alcohol. Severe toxicity, manifested as coma, occurs at lower blood alcohol concentrations in young teenagers than in adults. The effect of ethanol on the state of consciousness is directly proportional to blood alcohol concentration. Among children under 5 years of age the risk of hypoglycaemia is increased. A significant risk in acute alcohol intoxication is the rapid development of coma, which in cold environments could lead to fatal hypothermia. Preschool-age children are reported to eliminate ethanol twice as fast as adults, whereas young teenagers eliminate it at the adult rate. The biochemical disturbances in children 11 to 16 years of age with alcohol intoxication resemble those of adults. Mild acidosis of a respiratory or metabolic origin and mild hypokalaemia are common findings in young teenagers. Fluid replacement with glucose-containing fluids and follow-up are generally the only treatments needed for complete recovery. Motives leading to alcohol intoxication are a wish to get drunk, experimenting, problems in human relations, and attempted suicide. The underlying problems are often family-related, such as divorce, an alcoholic parent and a lower socioeconomic group.
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PMID:Alcohol intoxication in childhood and adolescence. 774 76


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