What are the treatment options for inability to regulate body temperature, also known as dysregulation of body temperature (hypothermia or hyperthermia)?

Treatment of Temperature Dysregulation

For patients unable to regulate body temperature, immediate treatment depends on whether they present with hypothermia or hyperthermia, with rapid cooling via whole-body cold-water immersion being the gold standard for heatstroke and active rewarming with warm blankets and heat sources being essential for hypothermia. 1

Initial Assessment and Emergency Activation

Activate emergency medical services immediately for any patient with altered mental status accompanying temperature dysregulation, as this indicates potential heatstroke (core temperature ≥40°C/104°F) or severe hypothermia requiring advanced care. 1

• In elderly patients, temperature dysregulation serves as a red flag for sepsis, which may present with atypical fever patterns or hypothermia, and requires immediate blood cultures, urinalysis, and complete blood count before starting empiric antibiotics. 2
• Core body temperature measurement (rectal preferred) is critical for determining severity and guiding treatment intensity. 1

Treatment of Hyperthermia/Heatstroke

Immediate Cooling Interventions

For adults with heatstroke, initiate immediate whole-body (neck-down) cold-water immersion for 15 minutes or until neurological symptoms resolve, targeting a core temperature below 39°C (102.2°F). 1

• Cold-water immersion (1-26°C/33.8-78.8°F) provides the fastest cooling rate and is the most effective method. 1
• Ice-water immersion produces cooling rates 0.14°C/min faster than temperate-water immersion. 1
• A six-person team is recommended for safe submersion to manage potentially combative or somnolent patients and maintain airway protection. 1

Alternative Cooling Methods (When Immersion Unavailable)

When water immersion is not feasible, use any of these active cooling techniques: 1

• Commercial ice packs applied to facial cheeks, palms, and soles (cooling rate 0.18°C/min faster than passive cooling). 1
• Cold showers (20.8°C/69.4°F) provide modest but significant cooling (0.03°C/min faster than passive). 1
• Ice sheets and towels rotated to neck, axillae, and groin. 1
• Cooling vests and jackets or evaporative cooling with mist and fan. 1

Supportive Measures for Heat Illness

• Move the patient from the hot environment and remove excess clothing immediately. 1
• Provide cool liquids if the patient can swallow safely. 1
• For heat exhaustion (without altered mental status), rest in a cool environment with electrolyte-carbohydrate beverages like juice or milk is sufficient. 1
• Stop cooling when core temperature reaches 38.6°C (101.4°F) to prevent iatrogenic hypothermia. 1

Critical Pitfall

Do not delay cooling while waiting for temperature verification—if clinical signs suggest heatstroke (altered mental status after heat exposure), begin cooling immediately. 1

Treatment of Hypothermia

Immediate Rewarming Interventions

Begin rewarming immediately by moving the patient to a warm environment, removing wet clothing, and wrapping all exposed body surfaces with blankets, clothing, or newspapers. 1

Active Rewarming Methods

For patients far from definitive healthcare, initiate active rewarming: 1

• Place the patient near a heat source. 1
• Apply containers of warm (not hot) water in contact with the skin. 1
• Active rewarming should not delay transport to definitive care. 1

Frostbite Management Considerations

• Remove wet clothing and protect frostbitten extremities from further use (walking, climbing). 1
• Do not rewarm frostbite if there is any chance of refreezing or if close to a medical facility. 1
• For severe frostbite requiring rewarming, immerse in warm water (37-40°C/body temperature) for 20-30 minutes within 24 hours of injury. 1
• Apply bulky, loose, circumferential dressings after thawing to protect vulnerable tissue and allow for swelling. 1
• Consider ibuprofen or NSAIDs to decrease prostaglandin-mediated vasoconstriction, though direct evidence is limited. 1

Critical Pitfall

Never use chemical warmers directly on frostbitten tissue—they can reach temperatures causing burns. 1

Special Population Considerations

Children with Heatstroke

For children with heatstroke, immediate whole-body cold-water immersion for 15 minutes is reasonable, using the same approach as adults. 1

• Children are particularly vulnerable to heat illness due to less efficient thermoregulation. 1, 3
• Prompt rapid cooling for 10-15 minutes with hydration (if alert enough to swallow) should be initiated while awaiting medical assistance. 1

Elderly Patients

• Elderly patients may present with atypical temperature patterns during serious infections, making dysregulation a marker for sepsis. 2
• Look specifically for altered mental status, leukopenia, thrombocytopenia, and elevated liver enzymes. 2
• Both children and elderly are particularly vulnerable to temperature dysregulation due to impaired thermoregulatory mechanisms. 3

Monitoring and Transport

• Continuous core temperature monitoring (rectal preferred) is essential throughout treatment. 1
• Ensure receiving hospitals have resources to continue cooling or rewarming as needed. 1
• For suspected sepsis with temperature dysregulation, broad-spectrum antibiotics should not be delayed after cultures are obtained. 2