When to initiate salt tablets for hypothermia?

From the Guidelines

Salt tablets are not recommended for treating hypothermia, and instead, the primary treatment involves rewarming the body through passive external warming, active external warming, or active core warming depending on severity. The most recent guidelines from the American Heart Association, as outlined in the 2024 guidelines for first aid 1, emphasize the importance of rewarming and do not mention salt tablets as a treatment for hypothermia. Hypothermia causes physiological changes, including vasoconstriction and altered fluid balance, but salt supplementation is not part of standard treatment protocols.

Key Considerations for Treatment

• Focus on gradual rewarming to prevent further heat loss
• Maintain airway and circulation
• Address any underlying causes of hypothermia
• In severe cases, medical professionals may administer warm IV fluids, which contain balanced electrolytes rather than just sodium, to help raise core temperature

Severity-Based Treatment Approaches

• Mild hypothermia: passive rewarming is generally adequate
• Moderate hypothermia: external warming techniques are appropriate
• Severe hypothermia: core rewarming is often used, and cardiopulmonary bypass can be an effective method for rapid rewarming in cases of cardiac arrest

If you suspect hypothermia, seek immediate medical attention as it can be life-threatening, especially when body temperature falls below 95°F (35°C). The treatment of severe hypothermia remains controversial, but the primary goal is to rewarm the body safely and effectively, without the use of salt tablets, as supported by the guidelines from the American Heart Association 1 and previous studies 1.

From the Research

Initiation of Salt Tablets for Hypothermia

There is no direct evidence in the provided studies regarding the initiation of salt tablets for hypothermia.

Rewarming Strategies for Hypothermia

• The management of hypothermia involves rapid recognition and aggressive intervention to prevent organ failure and death 2.
• Rewarming is the only approach that should be considered for hypothermia treatment, but it is of low efficiency, and few active rewarming cases have been reported 3.
• Prehospital management of hypothermia is crucial, and treatment should ideally begin prehospital to prevent or manage deterioration of a cold patient 4.
• Various rewarming methods are available, including passive insulation, active external rewarming, and extracorporeal rewarming, and the choice of method should be based on the patient's condition, hemodynamic stability, and available resources 2, 4.
• Renal replacement therapy (RRT) can be used to rewarm patients in deep hypothermia, but there is still no clear evidence for its effectiveness in this group of patients 5.

Considerations for Hypothermia Treatment

• Hypothermia can induce a vicious cycle of synergistic effects of hypothermia, acidosis, and coagulopathy, referred to as the trauma triad of death 4.
• Timely reperfusion is the best way to save the lives of patients with ischemia, but improper reperfusion of ischemic tissues and reoxygenation of hypoxic tissues can give rise to further injury 3.
• The choice of rewarming method should always be determined by the specific clinical circumstances, available resources, and current resuscitation guidelines 5.