Hemodialysis for Treatment of Accidental Hypothermia

Abstract

Accidental hypothermia is defined as a spontaneous decrease in core temperature to 35°C or below. Several techniques of active core rewarming have been described. We present the case of a 34-year-old man with severe hypothermia (27 °C) caused by cold environment exposure and barbiturate intoxication treated with general supportive measures and active core rewarming with hemodialysis. Core temperature increased by 2.15^¤C/h with hemodialysis and became normal in 4 h. The clinical situation clearly improved during the hemodialysis session and the patient recovered without any defect. Hemodialysis is a rapid and effective treatment for accidental hypothermia.

Treatment of severe accidental hypothermia with intermittent hemodialysis

“…This rewarming rate is consistent with previous reports (Table 1). 9,13,14,[16][17][18] Importantly, there were no further incidents of core temperature after-drop during hemodialysis. Although CPB can achieve more rapid rewarming rates of 7-12°C/h, the relative benefits and harms of such rapid rewarming rates have not been definitively established.…”

“…We found 6 reported cases of patients who were treated with hemodialysis for hypothermia, 9,13,14,16-18 of whom 2 had renal failure. 16,18 Of the 4 with normal renal function, 2 were treated with intermittent hemodialysis 13,14 and 2 with continuous hemodialysis. 9,17 In contrast, peritoneal dialysis has been more widely used, based on more than 40 published reports.…”

“…19 Hemodialysis may be a more effective rewarming method when compared with peritoneal dialysis, as hemodialysis has been successfully used in peritoneal dialysis failures. 13,16 Whether continuous hemodialysis is superior to intermittent hemodialysis requires further study.…”

“…We found only 2 reports on the use of intermittent hemodialysis in hypothermic patients without renal failure. 13,14 We describe a case of severe hypothermia in a patient without renal failure who was treated with intermittent hemodialysis after initial failed attempts with active external and core rewarming. This case highlights the advantages and challenges of using hemodialysis in treating hypothermia.…”

Early Use of Hemodialysis for Active Rewarming in Severe Hypothermia: A Case Report and Review of Literature

“…Several extracorporeal techniques have been used to directly rewarm blood: cardiopulmonary bypass (CPB), 11,12 continuous arteriovenous rewarming (CAVR), 13 continuous venovenous hemofiltration (CVVH), 14 continuous venovenous hemodiafiltration (CVVHDF), 15 and hemodialysis (HD). [16][17][18][19][20] Currently, an active internal rewarming strategy for patients with severe hypothermia has not been established. HD is an attractive modality for active internal rewarming given its wide availability and its ability to manage associated metabolic derangements as well as allow infusion of warmed IV fluid.…”