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

After long-standing malnutrition a 15-month-old boy with signs of kwashiorkor was admitted in a moribund state with serious hyponatraemic dehydration, hypothermia, somnolence, and signs of a pontine disconnection syndrome. Folic acid levels were below the detection level in the presence of normal cobalamin levels. MRI of the brain showed global volume loss and signal abnormalities on the T2-weighted images suggestive for central pontine myelinolysis (CPM). Brainstem acoustic evoked responses have remained normal. The serious metabolic and nutritional derangements required substitution of folic acid, vitamins and trace elements as well as slow correction of hyponatraemic dehydration with return of the sodium level over a period of four days. This therapeutic regimen resulted in complete neurological recovery. Follow-up MRI documented normalisation of the initial pathologic findings. The hypothesis was put forward linking the pathogenesis of CPM with the combination of folate depletion and superimposed hyponatraemic dehydration. The previously acquired folate depletion could affect normal appositional function of myelin basic protein molecules due to insufficient methylation of arginine in position 107. The subsequent development of intramyelinic edema and CPM will then be triggered by the superimposed hyponatraemic dehydration. The verification of this hypothesis requires further investigations.
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PMID:Central pontine myelinolysis associated with acquired folate depletion. 920 15

A variety of age-related physiologic factors and disease states predispose older patients to hypothermia. These include a decreased ability to produce heat, malnutrition, medications, infections, and social factors such as isolation and poverty. The subtle clinical signs and symptoms of mild hypothermia may mimic cognitive decline, cerebral vascular accident, hypothyroidism, or myxedema coma. The challenge for the physician is to clinically recognize hypothermia and provide prompt diagnosis and treatment. Medical management of the older patient with moderate to severe hypothermia requires in-hospital intensive care, as life-threatening conditions may arise during stabilization and resuscitation.
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PMID:Hypothermia: an easy-to-miss, dangerous disorder in winter weather. 1002 73

On the day of hatching, four groups of poults [Control, L-tryptophan methylester (LTME), Bordetella avium-infected, and B. avium-infected plus LTME] were established and placed into heated metal brooding batteries. Bordetella avium infection caused a significant depression in body temperature within 24 h after intranasal challenge with the W strain, and the hypothermia persisted through 21 d of age. L-Tryptophan methylester, a water-soluble form of tryptophan, was given by oral gavage daily in saline at a concentration of 50 mg per poult beginning 4 d after hatch. Within 2 d after initiation of LTME treatments, colonic temperature of B. avium-infected poults was elevated to the level of Controls and remained at that level throughout the experimental period. The BW of B. avium-infected poults were reduced significantly. The LTME treatment caused a significant BW increase in the B. avium-infected poults, but the increase was not to the level of Controls. The anti-sheep red blood cell antibody titers in B. avium-infected poults were not affected significantly. However, LTME treatment induced a significant increase in anti-sheep red blood cell antibody titers in both the infected and Control poults. Based upon data reported herein, it was concluded that feed intake depression associated with development of bordetellosis caused the poults to react more specifically to a mild tryptophan deficiency than to other nutrient deficiencies. The tryptophan deficiency caused a growth depression that was only partially alleviated by daily supplementation of LTME. The physiological responses to daily supplementation of LTME to B. avium-infected poults suggested that growth depression and poor performance was not limited to dietary deficiency of tryptophan.
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PMID:Tryptophan methylester modulation of poult responses to Bordetella avium. 1009 Feb 57

Profound hypothermia (core temperature of less than 28 degrees C) is a life threatening state and a medical emergency associated with a high mortality rate. The prognosis depends on underlying diseases, advanced or very early age, the duration prior to treatment, the degree of hemodynamic deterioration, and especially, the methods of treatment, including active external or internal rewarming. This is a case study of an 80-year-old female patient with severe accidental hypothermia (core temperature 27 degrees C). She was found in her home lying immobile on the cold floor after a fall. The patient was in a profound coma with cardiocirculatory collapse, and the medical staff treating her was inclined to pronounce her deceased. On her arrival at the hospital, she was resuscitated, put on a respirator and actively warmed. Very severe metabolic disorders were found, including a marked metabolic acidosis composed of diabetic ketoacidosis (she had suffered from insulin treated type 2 diabetes mellitus) and lactic acidosis with a very high anion gap (42) and a hyperosmotic state (blood glucose 1202 mg/dl). There were pathognomonic electrocardiographic abnormalities, J-wave of Osborn and prolonged repolarization. Slow atrial fibrillation with a ventricular response of 30 bpm followed by a nodal rhythm of 12 bpm and reversible cardiac arrest were recorded. The pulse and blood pressure were unobtainable. Despite the successful resuscitation and hemodynamic and cognitive improvement, rhabdomyolysis (CKP 6580 u/L), renal failure and hepatic damage developed. She was extubated and treated with intravenous fluids containing dopamine, bicarbonate, insulin and antibiotics. Her medical condition gradually improved, and she was discharged clear minded, functioning very well and independent. Renal and liver tests returned eventually to normal limits. Progressive bradycardia, hypotension and death due to ventricular fibrillation or asystole commonly occur during severe hypothermia. Respiratory and metabolic, sometimes lactic, acidosis, lethargy and coma, hypercoagulopathy, hyperosmolar state, acute pancreatitis and renal and hepatic failure are frequent complications of hypothermia. Underlying predisposing causes of hypothermia are diabetic ketoacidosis, cerebrovascular disease, mental retardation, hypothyroidism, pituitary and adrenal insufficiency, malnutrition, acute alcoholism, liver damage, hypoglycemia, sepsis, hypothalamic dysfunction, sepsis and polypharmacy, and especially, the use of sedative and narcotic drugs. Our case demonstrates once again that CPR once begun should continue until the successful rewarming because "no one is dead until warm and dead".
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PMID:[Severe accidental hypothermia in an elderly woman]. 1175 73

At a Children's Nutrition Unit in Bangladesh, a screening process has been developed to determine the type of care which should be provided to malnourished children. Malnourished children receive an initial period of full-time medical attention if they exhibit apathy and anorexia, dehydration, severe anemia, life-threatening infection, hypoglycemia, hypothermia, or severe Vitamin A deficiency. Also, malnourished children under 12 months old are given preference for in-patient care. Children may be hospitalized for three to five weeks until they are reasonable recovered and have reached a target weight-for-height or they may be discharged early and receive continued treatment through day care or home visits. Goals of the minimum stay (one to two weeks) should include restored appetite, treatment of clinical complications, and teaching the mother about appropriate feeding. Hospitalization and day care in the hospital may be very difficult for a family to manage. Home-based treatment, on the other hand, produces good, although slower, results and is the most cost-effective approach. Success of home care depends upon the quality of care and advice given during home visits by health personnel and an effective referral system if the children need more attention. In this program, while the provision of a Vitamin and mineral mixture is considered helpful, food supplements are not distributed. Even very poor families can adapt family foods to provide better nutrition. Less malnourished children also need attention, and their mothers must be trained to adapt family foods, give frequent meals, and continue to breast feed. Action is needed when growth begins to falter to prevent the need for later treatment. In Dhaka, the total cost to rehabilitate one child is US$29 for home-based care, US$59 for day care, and US$156 for in-patient care.
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PMID:Fighting malnutrition from hospital to home. 1229 32

This article draws attention to the consequences of severe malnutrition for child survival in developing countries and the international efforts to effectively deal with nutrition problems. Severe malnutrition in developing countries affects an estimated 69 million children under 5 years of age. The most severe form of malnutrition results in marasmus and kwashiorkor and adult growth deficiencies, which affect the ability to work and, for women, the ability to bear normal-weight children. Severely malnourished children, even with treatment, die. The Public Health Nutrition Unit at the London School of Hygiene and Tropical Medicine developed a set of 10 guidelines for the care of severely malnourished children in order to prevent high mortality of malnourished children during treatment. Care varies between the first 1-2 days, days 2-7, and weeks 2-6. During the first several days, the child needs to be stabilized by preventing and treating hypoglycemia, hypothermia, and dehydration. During days 2-7, it is time to treat infections and start cautious feeding. During weeks 2-6, it is time to rebuild wasted tissues and prepare for follow-up. During all three time periods, there is a need to correct the imbalance of electrolytes, correct deficiencies of micronutrients, and provide stimulation and play. Iron supplementation is not provided until the second week. The 1992 International Conference on Nutrition identified the need to develop resources, such as strengthening existing capabilities and improving appropriate training. The WHO and UNICEF initiative on Integrated Management of Child Care uses the treatment guidelines and will be preparing training programs to teach relevant skills for the treatment of childhood illness and malnutrition. Training materials are being developed. The final phase will include the establishment of centers for training in the treatment of severely malnourished children.
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PMID:Reducing mortality rates in severely malnourished children. 1229 76

This article offers a protocol for reducing high case fatality rates from malnutrition. Most child deaths from malnutrition occur in the first few days of treatment. Treatment should involve stabilization followed by rehabilitation. The article describes the treatment procedures for hypoglycemia, hypothermia, dehydration, and missed infections and discusses feeding during the stabilization and rehabilitation phases of treatment. All severely malnourished children have excess body sodium but high intracellular and low plasma levels. Malnourished children have deficiencies of potassium and magnesium that may take 2 weeks to correct. Edema is partly due to deficiencies in potassium and magnesium. A high sodium intake can be corrected by rehydrating with a modified oral rehydration solution and the special starter formula. Family food should be prepared without salt. Magnesium and potassium should be added directly to foods. All severely malnourished children have vitamin and mineral deficiencies. Deficiencies may include vitamin A, zinc, copper, selenium, and folic acid. Multivitamin supplements can correct for micronutrient deficiencies. It is advised that zinc should not be ignored, since it is responsible for repair of intestinal mucosa, halting diarrhea, healing of ulcerated skin lesions, restoration of appetite, improved immune function, and lean tissue synthesis. Iron should not be given until growth starts, infections are controlled, and antioxidant status is improved (usually 1 week after admission). Early introduction of iron poses a risk of enhancing pathogen increases and stimulating production of toxic free radicals. Relapses can be reduced by training parents how to feed their child frequently with energy and nutrient dense foods. The regimen was tested in a South African project and found to reduce mortality from 30% to 20%. After greater hospital attention to treatment of sepsis and hypoglycemia, case fatality declined to 6%.
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PMID:Severe malnutrition in children: high case-fatality rates can be reduced. 1232 Dec 37

A 15-year-old female with short intestine syndrome due to chronic intestinal pseudo-obstruction associated with kidney failure underwent a multivisceral (stomach-duodenum-jejunum-ileum-pancreas-liver) and kidney transplant. She had required parenteral nutrition for the last 5 years, with numerous complications such as sepsis from the central catheter, deep venous thrombosis, severe liver dysfunction, pancytopenia due to bone marrow failure, and severe malnutrition. Surgery lasted 15 hours and was free of complications other than hypothermia, which worsened after revascularization of the grafts. Replacement of 6 units of blood products and crystalloids was required. Biochemical and hemodynamic variables were stable, apart from the development of hypernatremia, hyperglycemia, and lactic acidosis. The anesthetic approach included preoperative assessment of problems related to chronic parenteral nutrition (liver dysfunction, coagulopathy, and restricted venous access), the prevention of hypothermia, correction of electrolyte imbalance and the acid-base status, treatment of reperfusion syndrome, and the replacement of fluids and blood products to maintain circulatory homeostasis and assure sufficient splanchnic perfusion.
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PMID:[Anesthesia for a pediatric multivisceral transplant]. 1507 2

Young people are our human capital for the future, therefore child and adolescent health has attracted considerable political and professional attention in recent years. Health is indivisible, requires holistic approach throughout the individual's life. Healthy outcome at one point in the life cycle, provides a positive determinant for health elsewhere in the cycle. Health and development of the 0-19 age group links intimately, at both ends of the range, with reproductive health. Health during childhood is in part determined by the health of the mother, and affected also by factors such as the nutrition of adolescent girls and the avoidance of early pregnancy. These factors, in turn, are influenced by healthy growth and development in childhood. The paper presents main environmental and socio-cultural challenges for each of the stages of child and adolescent life. Main challenge described are: unsafe abortion, malnutrition, anaemia, malformations, and infections during pregnancy; low birth weight, asphyxia, hypothermia, infection, failure to initiate early and full breastfeeding in the neonatal period; poor nutrition, growth and development, frequent illnesses, injury, abuse and neglect in the early childhood; poor nutrition, growth and development, injury, abuse, neglect, and helminth infections in the early school age; poor nutrition, poor development, chronic conditions, mental disorders, injury, drug abuse, and violence in the adolescence. Both, prevention of ill health and care for illnesses are important at all times but the balance between them shifts over time during the childhood and adolescence. Main actions needed to meet the child and adolescent needs are presented as well.
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PMID:Life cycle approach to child and adolescent health. 1550 17

Neglect, defined as the failure of a caregiver to adequately provide safety, food, clothing, shelter, education, protection, medical/dental care, and supervision for a child in his/her care, is a relatively uncommon but important cause of child mortality. A retrospective review of pediatric deaths (age 18 years or less) referred to the Medical University of South Carolina Forensic Pathology Office for autopsy over the past 25 years revealed 16 deaths due to some type of pediatric neglect. Cases were analyzed as to age, sex, race, cause and manner of death, autopsy findings, ancillary studies, past medical history, social/family history, and caregiver. Six cases of malnutrition/starvation and/or dehydration were identified, composing the most common cause of death in the neglect cases identified and the majority of the homicides due to neglect. Other deaths in which neglect contributed significantly included toxic ingestions (2 cases), hyper-/hypothermia (2 cases), unusual drowning/aspiration (4 cases), electrocution (1 case), and delayed/absent medical therapy (2 cases, including one of the previously mentioned ingestions). Of these additional cases, 7 were certified as accidental manner, 2 as natural, and 1 as a homicide. Cases which fell into a "gray zone" in which the appropriateness of invoking neglect was a matter of opinion or societal convention were excluded from the review; examples included conventional accidental drowning, choking on food or aspiration of foreign body, overlying/wedging during sleep, accidental hanging, and motor-vehicle traffic accidents (pedestrians, unrestrained passengers). The findings of this review reinforce the fact that malnutrition/starvation and dehydration compose the most common form of lethal pediatric neglect while highlighting less common forms of neglect and the difficulty of determining manner of death in cases in which neglect plays a more questionable role than in seemingly clear-cut malnutrition/starvation and dehydration cases. We demonstrate the typical victim and scenario that investigators will encounter in cases of fatal pediatric neglect, often a child under the age of 1 year who has been deprived of food and/or drink for some time, or an older, more independently mobile child who has not been adequately supervised. These children may or may not have a demonstrable prior history of maltreatment or (nonfatal) neglect, and review of medical records is an important part of the investigation. We additionally discuss key gross autopsy findings, appropriate specimen collection, helpful ancillary studies, microscopic findings of significance, potential mimickers of neglect, and other special considerations in cases of pediatric neglect.
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PMID:A 25-year retrospective review of deaths due to pediatric neglect. 1612 Oct 76


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