Hypoglycemic hypothermia

Introduction The risk of diabetes-induced hypothermia is six times higher than that of non-diabetes, which may be related to autonomic, peripheral, and vascular lesions. 50% of patients with hypoglycemia can develop hypothermia. Hypothermia refers to a state in which the deep temperature of the human body (rectal, esophagus, tympanic cavity) is lower than 35 ° C (95 ° F). The cause of hypothermia is caused by a heat-producing disorder, such as hypothyroidism. It is also caused by excessive heat dissipation, such as exposure to low temperature environment for too long. The elderly may have a lack of body temperature due to insufficient nutrient calories, poor body temperature regulation, insufficient heat preservation, and diseases.

Cause

(1) Causes of the disease

Exogenous factors

The cause of accidental hypothermia is external and internal factors, most of which are exogenous factors, that is, exposure to cold environment or drowning in cold water. In addition, insufficient heat supply, as well as wind and humidity, can also increase body heat loss through convection and evaporation, respectively.

2. Internal factors

Internal factors are extremely important for elderly patients with hypothermia, and can be divided into physiological and pathological causes, that is, physiological dysfunction of body temperature regulation and accompanying various basic diseases and drugs for reducing heat energy are important causes of accidental hypothermia in the elderly.

(1) Physiological reasons: The body temperature can be kept constant, and the physiological heat is used to balance the generation and divergence of heat in the body. When the human body is in a cold environment, the body excites the sympathetic nerve through the hypothalamic temperature regulation center on the one hand, and the heart rate is accelerated, and the skin blood vessels contract to preserve the body heat. On the other hand, it promotes muscle chills (ie, reaction) and promotes the secretory function (late response) of the thyroid and adrenal glands to increase calorie production. In the elderly, the above-mentioned autonomic thermoregulatory function is impaired, which is manifested by the skin's vasoconstriction response to cold, or even no response, and abnormal peripheral blood flow patterns (reduced peripheral blood flow at rest, 2 ° C temperature difference) Some even have a temperature difference of more than 5 ° C. This physiological disorder of body temperature regulation is the cause of accidental hypothermia in the elderly.

(2) Pathological reasons: Although the elderly may cause primary accidental hypothermia due to physiological disorders in cold environment and body temperature regulation, more common are pathological causes, ie secondary hypothermia, many important The underlying disease can be secondary to hypothermia.

1 severe infection: sepsis can be manifested as hypothermia without fever, and is a sign of poor prognosis, so sepsis should not wait until fever to do blood culture, bronchial pneumonia with hypothermia, often caused by other causes of hypothermia, after induction Bronchopneumonia.

2 endocrine diseases: mucinous edema and hypopituitarism due to insufficient heat production and hypothermia, the mortality rate is significantly increased. Hypothermia caused by steatorrhea may also be associated with hypopituitarism. The risk of diabetes-induced hypothermia is six times higher than that of non-diabetes, which may be related to autonomic, peripheral, and vascular lesions. 50% of patients with hypoglycemia can develop hypothermia, which can be used as an important diagnostic clue. In order to give glucose treatment quickly. Diabetes insipidus and Edison's disease can also cause hypothermia.

3 central nervous system and motor system diseases: cerebrovascular accident, subarachnoid hemorrhage, subdural hematoma, brain tumor, cranial trauma and spinal cord injury can all disturb the hypothalamic thermoregulation and cause hypothermia, of which Wernicke's hemorrhagic Encephalopathy (acute hemorrhagic polio) is particularly noteworthy. It is a vitamin B deficiency caused by alcoholism and is characterized by hemorrhagic lesions in the third ventricle, cerebral ventricle and papillary body. Without thinking about the disease in time, the chance of applying thiamine treatment will be lost, and the disease that is easy to treat will be worsened. Many neurological and motor system disorders can cause hypothermia due to limited activity and insufficient heat production. Parkinson's disease is caused by autonomic dysfunction caused by hypothermia. Falling is also one of the causes of this disease. When the elderly fall into the toilet at night, they may lie on the floor for a long time because they are unable to climb up, causing a large loss of body heat and causing hypothermia.

4 drugs and alcohol: the use of drugs is a cause of a large number of hypothermia. Many drugs such as sedation, benzodiazepine, antidepressants, and alcohol can inhibit central and peripheral thermoregulatory mechanisms and cause hypothermia. People who use medicine can feel cold, but they can't warm themselves up, and chills may be suppressed. The drugs most likely to cause hypothermia, including phenothiazine antipsychotics, tricyclic antidepressants, benzodiazepines and barbiturates sedative hypnotics, anesthetics, etc., such as chlorpromazine can inhibit trembling, It is the most well-known cooling medicine. Heavy drinking not only inhibits the body's thermoregulatory center, but also causes hypothermia by dilating peripheral blood vessels.

5 mental factors: mental disorders and dementia may lack the alertness to the cold, often accompanied by thermoregulatory dysfunction, coupled with the application of psychotropic drugs to induce hypothermia. Depression, especially after the loss of a loved one, is a common cause of hypothermia. Their life's courage is frustrated and may refuse to eat, drink, or warm. In addition, antidepressants often inhibit tremors and may further exacerbate hypothermia.

6 other diseases: malnutrition and cachexia are also important causes of secondary hypothermia in the elderly. Burns, exfoliative dermatitis, and Paget's disease may cause skin damage and increased distribution of blood vessels on the surface, causing a large loss of body heat and causing hypothermia. Acute myocardial infarction and pulmonary embolism can cause acute disorders of thermoregulatory mechanisms. Urinary incontinence also tends to cause hypothermia, one to dissipate heat; the other is to cool the body when the urine comes into contact with the body. In short, the causes of senile hypothermia are multifaceted and can be broadly classified into three categories:

A. Social factors:

a. Lonely life. b. Drink plenty of alcohol. c. The ambient temperature is low.

B. Physical factors:

a. Endocrine diseases. b. Nervous system diseases. c. Exercise system diseases. d. Cardiovascular disease. e. Respiratory diseases. f. Gastrointestinal diseases. g. Chronic wasting disease. h. Iatrogenic diseases. i. Fall. j. Severe infection. k. Aging.

C. Spiritual factors:

a. Depression. b. Insanity. c. Dementia.

(two) pathogenesis

The pathogenesis of senile septic disease has not been elucidated. It is generally believed that body temperature regulation of physiological dysfunction and accompanying various underlying diseases and reduction of heat production are important causes of hypothermia in the elderly.

an examination

Related inspection

Blood glucose temperature measurement

Blood tests and C-fetal release tests are available.

Differential diagnosis

It is also difficult to judge the various primary diseases that cause hypothermia, and should be highly vigilant due to hypothyroidism, diabetes, myocardial infarction, bronchial pneumonia, and central nervous system disorders with secondary hypothermia. For patients with hypothermia who have no obvious cause, especially those who are in a coma state, there should be no drugs that cause hypothermia in plasma or urine.

Whether it is primary or secondary hypothermia, all systems and organs of the body can suffer varying degrees of damage, but clinical manifestations are often non-specific.

Appearance

Due to the mixed appearance of pale and blemishes on the face, the patient's face was grayish, sometimes with a specific pink color and suspected of carbon monoxide poisoning. The skin is cold. Facial swelling, sluggish speech, and hoarseness can be misdiagnosed as mucinous edema. When the patient's body temperature returns to normal, the above symptoms disappear.

2. Central nervous system

Mild hypothermia occurs when there is chills, the central nervous system presents ataxia, dementia, dysphonia or slow, illusion changes, etc., often mistaken for "aging." Body temperature and lethargy. The body temperature is coma, the reflection disappears, the pupils on both sides are of different sizes, and the response to light is weak.

3. The respiratory system begins to be ineffective due to inhibition of the respiratory center, with few symptoms. As the body temperature drops, the breathing becomes slower and shallower, and ventilation is insufficient. The sound that appears at the bottom of the lung is not entirely due to infection, and there may be pulmonary edema. Insufficient cough, reduced cough reflexes, and cold stimulation of the bronchopulmonary, resulting in increased secretion, difficulty in removing sputum, can lead to aspiration pneumonia, pulmonary edema, secondary infections and atelectasis, the latter can smell pronunciation . At low temperature, the hemoglobin oxygenation curve shifts to the left, which reduces the oxygen release at the tissue level, increases the anaerobic metabolism and reduces the respiratory ventilation, leading to severe respiratory acidosis and eventually respiratory failure.

4. Cardiovascular system

Common cardiac output reduction, hypotension, bradycardia and atrial fibrillation. Hypoglycemia should be thought of if tachycardia occurs. Electrocardiogram often has different degrees of conduction block, and can have indoor conduction delay, and various forms of arrhythmia, including atrial fibrillation, atrial flutter, ventricular premature contraction and ventricular autonomic rhythm. A more common ECG change is the baseline swing of a small rule, which is formed by an increase in muscle tension that does not detect trembling.

5. Urinary system

In patients with hypothermia, oliguria and acute tubular necrosis can occur due to ischemia and direct damage to the kidneys. In the early stage, due to the decrease of renal tubular activity, "cold polyuria" may also occur, resulting in hypovolemia and prerenal azotemia.

6. Digestive system

Often acute pancreatitis and mumps, the former often lack of signs, only serum amylase increased, such as forced compression of the upper abdomen patients who cringe and suspected of this disease. Gastrointestinal function often occurs, peristalsis is weakened, paralytic ileus and gastrointestinal bleeding occur, abdominal bloating and bowel sounds are weakened. When liver function is impaired, blood pH decreases and liver detoxification is low.

7. Blood system

Blood concentration, increased blood viscosity, thrombocytopenia, and DIC can occur.

8. Endocrine system

Hyperglycemia can occur due to reduced insulin release and reduced effects, resulting in reduced glucose utilization. Adrenal cortical damage can be misdiagnosed as Edison's disease, but the symptoms disappear when the body temperature rises. Both thyroid and pituitary functions are damaged to varying degrees.

Physicians need to be highly vigilant in order to diagnose hypothermia in a timely manner, because hypothermia is often misdiagnosed, and medical staff are wary of finding and excluding fever, and negligently searching for and eliminating hypothermia. The diagnosis of accidental hypothermia includes medical history, clinical symptoms, physical examination and laboratory tests. Elderly patients with hypothermia often live alone because they often get out of bed at night and are exposed to cold conditions. In terms of clinical symptoms, the following signs should be suspected and the disease:

1 facial swelling, pale waxy skin, or a specific pink.

2 One side of the body, upper limbs or lower limbs tremble.

3 arrhythmia, unclear language, slow breathing and shallow and difficult to see.

4 low blood pressure.

5 lethargic or fall into a coma, unconscious.

Regarding the examination method of the body temperature, it is known that the oral temperature is very unreliable for measuring the deep body temperature, and the disease is easily missed, and the ordinary body thermometer can only measure 34.4 ° C for the minimum body temperature, so it is not suitable for patients with hypothermia. For suspicious elderly patients who are in a cold environment or have normal body surface appearance and have a reduction in body surface temperature and various basic diseases mentioned above, a low reading thermometer should be used and inserted into the rectum for 5 minutes for 5 minutes. This is a common test method for measuring body temperature. . In addition, there is a resistance thermometer placed in the external auditory canal to continuously monitor the deep body temperature of the ear canal. It is worth noting that when the oral temperature cannot rise above 35 °C, it is unforgivable not to measure the rectal temperature of elderly patients.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.