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Acute Disease Case Study: Metabolism Hypothermia

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14 March 2013

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OUTLINE
I. Introduction.
II. Living before contracting the disease.
A. Risk factors.
B. Prevalence and incidence.
C. Early warning signs.
III. Establishing the diagnosis.
A. Symptoms and complaints.
B. Physical examination and tests.
C. Test findings and pathophysiology of the disease.
III. Treating the disease.
A. Types of treatment provided.
B. Survival and prognosis.
IV. Conclusion.

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Acute Disease Case Study: Metabolism Hypothermia
Introduction
We rarely think of the risks and consequences of an acute disease, until we
face it. Our organism often warns us of the upcoming challenge, but we ignore these
signs. Hypothermia is an acute health diagnosis that does not happen at once but
can have devastating impacts on all human organs and systems. I could not imagine
that I would ever be admitted to a hospital with hypothermia. Now I keep suffering
from the damaging consequences of my mistakes, because it is always better to
prevent a disease than to deal with its complications.
Living before contracting the disease
I am a 79-year-old man. My wife died two years ago. Since then, I have been
trying to find my way in life. Before Eleanor died, she had always cared for me. I
never thought I had to cook, clean, or use the laundry machine. Everything in my life
was organized. Eleanor knew that I had to care for my health. She made regular
appointments with my physician and knew how I felt. She monitored how I took
medicines and made sure I never missed a visit to the hospital. After her death two
years ago, I could hardly understand how I would survive. Drinking became a daily
routine for me. I forgot about proper nutrition and ate, whatever I could find in the
nearest store. Within months, I lost nearly 20 pounds, but my emotional grief left little
room to physical sufferings. I simply did not notice that the tragedy was coming. Last
winter, I nearly froze myself to death, as I could not find my way home. I was drunk.
By the time I reached home, my hands and legs were pale, and I started to feel
sleepy. This winter, the situation has been much worse: on my way to the food store,
I got lost in a snowstorm. I was hungry and drunk, and it is alcohol and hunger that
favored the rapid onset of hypothermia.

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I must say that, as an elderly person, I face higher risks of hypothermia than
my younger counterparts. According to Cire, "older people are at risk for hypothermia
because their body's response to cold can be diminished by certain illnesses such as
diabetes and some medicines, including over-the-counter cold remedies." Moreover,
elderly people's bodies do not generate enough heat to withstand extreme colds
(Cire). I ignored all precautions and did not think about hypothermia. I had few
clothes on me at the time of the snowstorm. I did not wear any gloves or hat. On the
same day, I was admitted to the hospital. Estimating the exact number of such
patients does not seem possible, mainly because emergency departments register
only the severest cases (Edelstein & Adler). Still, the rates of mortality in hypothermic
patients are quite high: between 12% and 40% of patients with moderate and severe
hypothermia are likely to die (Edelstein & Adler). These rates are similar for men and
women, but the youngest and the oldest ones are particularly susceptible to these
risks (Edelstein & Adler).
I should say, that my age was not the only risk factor for hypothermia.
Certainly, age matters, because older people may not be able to communicate or
move, when they are cold (Mayo Clinic). However, I was also drunk, and alcohol is
one of the most prevalent factors of hypothermia and poor metabolism (Mayo Clinic).
Alcohol leads to the dilation of blood vessels; as a result, the body loses heat faster
(Mayo Clinic). Being drunk, I was mostly indifferent as to what I was wearing, where I
was going, and what could happen to me. Poor nutrition further contributed to the
development of hypothermia: before the snowstorm, I had not eaten for several
days, and this is actually why I left home and went to the food store.
As I said earlier, hypothermia does not happen at once. Now I can remember
how I was getting cold on my way to the food store. At first, I felt how my hands, feet,

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and head were getting cold. My face was swelling and I could feel my skin going
pale. I cannot remember whether I was shivering, but I started to feel sleepy. I did
not care, because I attributed my state to alcohol and hunger. In a couple of hours, I
was not able to move. I was not able to speak. I sat down into the snow, because I
could not walk any longer. For some reason, I decided I had to wait until the
snowstorm was over. My heart was getting slower. Then, I could not remember
anything, until I opened my eyes in the emergency department.
Establishing the diagnosis
I was admitted to the nearest emergency department with the following
symptoms: shivering, clumsy speech, poor movements, poor decision making and
confusion, slow breathing and weak pulse (Mayo Clinic). I was also half conscious. I
felt as if my energy had left me (Mayo Clinic). I was not quite aware what was
happening to me. Mayo Clinic suggests that individuals with hypothermia may not
realize the severity of their condition, because the symptoms emerge gradually,
leaving individuals into confusion. This is, probably, what happened to me, because
even now I cannot remember the details of my being admitted to the hospital.
What I know is that I had to undergo all possible tests and diagnostic
procedures to confirm the diagnosis. Although the circumstances of my admission
made the diagnosis absolutely evident, my body temperature was measured. The
nurse used a rectal thermometer, which showed 28 oC (82.4oF) a boundary
condition between moderate and severe hypothermia (McCullough & Arora 2327). I
should say that, in a normal condition, my temperature would have to range between
36.0 and 36.6oC (97.8oF). The ECG showed decreased heart rate. Ventricular
arrhythmias were also noted. A blood test for alcohol was made, and the blood
alcohol concentration (BAC) was estimated at 0.10. Normally, such tests would show

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no alcohol. I do not think they measured any potassium or electrolyte levels,
because the symptoms of hypothermia were too obvious. At times, patients with
hypothermia may display the signs of coagulopathy, but I am not sure I had it
(McCullough & Arora 2328). What they said was that I had a metabolic disorder,
which made me extremely vulnerable to the risks of hypothermia. They told me I had
a decreased basal metabolic rate, which could have its roots in thyroid dysfunction
(McCullough & Arora 2327).

Fig.1. Safe cardiac arrest time against temperature (Walpoth et al. 391).
The pathophysiology of hypothermia is quite straightforward. Hypothermia is a
state that affects all organs and systems. I lost most heat through radiation,
convection, and conduction, coupled with respiration and active evaporation. Due to
the loss of heat and low temperature, my hypothalamus could not maintain adequate
levels of heat production and conservation (Edelstein & Adler). The CNS and
cardiovascular system suffered the most: the cardiac output and arterial pressure
kept decreasing and could lead to myocardial ischemia or sepsis (Edelstein & Adler).
Low temperatures led to decreased CNS metabolism, further reducing brain activity.
Every time body temperature falls by 1oC, cerebral metabolism decreases up to 10%
(Polderman S187). Oxygen consumption by tissues also continued to decrease

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(Edelstein & Adler). Not surprisingly, I could not manage my actions and thoughts
any longer. The level of consciousness was abnormally low. I was simply dying.
Treatment and prognosis
At first, the nurse removed my clothes, and I was placed under warm
blankets. I was given thiamine, because it has minimal adverse effects on the
patients with a history of alcohol abuse (McCullough & Arora 2329). Active external
rewarming was used to speed up an increase in the body temperature. My skin was
normal, and they used heating pads and hot water bottles to help me recover from
cold. I also believe that warm intravenous solutions were administered to make me
feel better (Mayo Clinic).
As a result of hypothermia, I also developed pancreatitis and aspiration
pneumonia. However, pancreatitis can also be attributed to the nutrition problems I
had been facing before hospitalization. I had to spend almost one month in a
hospital. Luckily, I was not admitted to intensive care. Today, I have to monitor my
nutrition and heart rate, while keeping warm and avoiding any alcohol. I believe that,
due to my age and health status, the long-term consequences of hypothermia will
continue to persist. I do not think I can fully recover from what happened to me, but I
am happy to be alive and conscious.
Conclusion
Hypothermia is a serious health condition which affects all organs and
systems. The consequences of hypothermia can vary considerably, from milder
complications to death. Age and alcohol abuse increase individual susceptibility to
hypothermia risks. It is always easier to prevent hypothermia than to deal with its
long-term consequences.

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Works Cited
Cire, Barbara. "Hypothermia: A Cold Weather Risk for Older People." NIH News, 16
Jan 2009. Web. 14 March 2013.
Edelstein, Jamie and Jonathan Adler. "Hypothermia." Medscape, 27 Apr 2011. Web.
14 March 2013.
Mayo Clinic. "Hypothermia." Mayo Clinic, 8 June 2011. Web. 14 March 2013.
McCullough, Lynne and Sanjay Arora. "Diagnosis and Treatment of Hypothermia."
American Family Physician, 70.12 (2004): 2325-2332. Print.
Polderman, Kees H. "Mechanisms of Action, Physiological Effects, and
Complications of Hypothermia." Critical Care Medicine, 37.7 (2009): S186S202. Print.
Walpoth, B.H., T. Locher, F. Leupi, P. Schupbach, W. Muhlemann & U. Althaus.
"Accidental Deep Hypothermia with Cardiopulmonary ArrestL Extracorporeal
Blood Rewarming in 11 Patients." European Journal of Cardio-Thoracic
Surgery, 4.7 (1990): 390-393. Print.