Causes and Risk Factors of Hypothermia

Understanding How Hypothermia Happens

hypothermia causes
Illustration by Joshua Seong. © Verywell, 2018. 

Hypothermia can be a medical emergency or a lifesaving medical intervention; it just depends on the context. Accidental hypothermia is caused by environmental factors including cold weather, cold water immersion, and also surgery. Therapeutic hypothermia is used to slow metabolic actions in certain situations to give the body time to heal before more damage is done.

Common Causes

Exposure to cold air or cold water is the biggest cause of hypothermia. Surprisingly, it doesn't take extremely cold weather to cause it. The only thing that matters is how cold the body gets. Chatting in the parking lot on a cool night with no coat is enough to reach mild hypothermia if you stand out there long enough. Indeed, the problem with hypothermia is that it creeps up on you.

If the weather isn't too cold, the body can stave off hypothermia by creating its own heat. The most obvious way the body does that is by shivering, although there are other metabolic processes using fat that create heat and help avoid hypothermia.

Mild hypothermia is often not reported or treated on temperate nights because when a patient reaches his tolerance level, he usually goes inside where it's warm and all is good. A little wind or a little water, however, can make it much worse. An incident in the Philippines demonstrates that even in the tropics, enough wind and rain can cause hypothermia.

Cold Water Immersion

The fastest cause of hypothermia is immersion in cold water. Water conducts heat away from the body about 25 times quicker than air. Falling into cold water is well known as a medical emergency.

Climbing out of the water with soaked clothes is also a problem. The wet clothing against skin continues to pull heat away.

One of the first steps in treating hypothermia is to remove wet clothing, even if it means the patient gets naked. A thin, dry blanket is better than a couple of layers of wet clothing.

However, one study found that falling in the water while clothed might be better. There is a layer of water next to the skin that acts as a thermal layer, trapping heat until the patient starts moving or trying to swim. Researchers were attempting to determine whether or not waiting for help is better than swimming to safety in cold water immersion. As it turns out, falling in with clothes on keeps the patient warmer, but trying to swim out with clothes on is more dangerous due to fatigue.

Wind Chill Factor

A convection oven cooks faster and more evenly by moving air across the roasting turkey. Cold winds work the same way in reverse. Cold air blowing across the body removes heat faster. Wind chill isn't just a trick of the body feeling as if the air is colder; it actually reduces temperature. The most dangerous combination is to have wind and cold water together.

Surgery

The environment isn't always about the weather. Patients in surgical situations can develop hypothermia for two reasons. First, they're naked.

Typically, surgical patients don't have much more than a blanket or two to keep them warm in a room often kept cooler than the average home.

Second, their guts are exposed. Skin works as a permeable insulation to keep heat in the body. When the skin is cut open and internal organs are exposed to outside air, the body is cooled very quickly.

Therapeutic Hypothermia

Not all causes of hypothermia are bad. Therapeutic hypothermia is a medical treatment modality intended to slow down metabolism in order to let healing catch up. Therapeutic hypothermia is mostly used after cardiac arrest resuscitation.

Genetic Risk Factors

Body fat, specifically brown fat, acts as both insulation and heat generator. Fat levels are often determined by genetic profile. Certain native populations have evolved adaptations to cold weather, such as metabolic adaptations of Native Americans that lead to higher metabolic rates and a higher core body temperature.

Women typically have lower resting metabolic rates than men and are generally more susceptible to hypothermia.

Cardiovascular Risk Factors

Patients with metabolic disorders like diabetes are more prone to hypothermia than other populations. Likewise, some patients with neurological disorders have trouble regulating core body temperatures.

If you know that you are at higher risk because of these circumstances, be mindful of common hypothermia causes so that you can take preventive measures.

Alcohol as a Risk Factor

The use of alcohol is one of the biggest risk factors that can cause hypothermia. Alcohol is a vasodilator, meaning that it opens up peripheral blood vessels and allows blood to flow freely to the surface of the skin. That blood flow puts patients with alcohol in their bloodstream at risk for hypothermia while at the same time feeling as if they are nice and warm.

Alcohol makes you feel as if you are warm by moving all that nice, warm blood closer to the temperature receptors located in the skin. Alcohol has such a reputation for warming you up that it is often touted as an elixir against the cold. Hot Toddy's are sold at nearly every ski lodge, luckily right next to the fireplace.

Unfortunately, blood so close to the surface allows more heat to escape the bloodstream and, ultimately, the body. Even though a drink or two may make you feel warm in the moment, you are now much more susceptible to hypothermia.

Sources:

Bowes, H., Eglin, C., Tipton, M., & Barwood, M. (2016). Swim performance and thermoregulatory effects of wearing clothing in a simulated cold-water survival situation. European Journal Of Applied Physiology116(4), 759-767. doi:10.1007/s00421-015-3306-6

Fudge, J. (2016). Exercise in the Cold. Sports Health: A Multidisciplinary Approach8(2), 133-139. doi:10.1177/1941738116630542

Gocotano, A., Dico, F., Calungsod, N., Hall, J., & Counahan, M. (2015). Exposure to cold weather during a mass gathering in the Philippines. Bulletin Of The World Health Organization93(11), 810-814. doi:10.2471/blt.15.158089

ishimura, T., & Watanuki, S. (2014). Relationship between mitochondrial haplogroup and seasonal changes of physiological responses to cold. Journal Of Physiological Anthropology33(1), 27. doi:10.1186/1880-6805-33-27

Klein, L., Cole, J., Driver, B., Battista, C., Jelinek, R., & Martel, M. (2018). Unsuspected Critical Illness Among Emergency Department Patients Presenting for Acute Alcohol Intoxication. Annals Of Emergency Medicine71(3), 279-288. doi:10.1016/j.annemergmed.2017.07.021