Hypothermia

Abstract

Hypothermia refers to a situation where there is a drop in body core temperature below 35 degrees C. It is a potentially fatal condition. In forensic medicine and pathology, cases of hypothermia often pose a special challenge to experts because of their complex nature, and the often absent or nonspecific nature of morphological findings. The scene of the incident may raise suspicions of a crime initially, due to phenomena such as terminal burrowing behavior and paradoxical undressing. An element of hypothermia often contributes to the cause of death in drug- and alcohol-related fatalities, in the homeless, in immersion deaths, in accidents and in cases of abuse or neglect, making the condition extremely relevant to forensic medical specialists. The aim of this review is to give an overview of the pathophysiological aspects of hypothermia and to illustrate different aspects relevant to forensic medical casework.

The Evaluation of the Deaths Related to Hypothermy in Eskisehir between 1997 and 2016

“…Hypothermic death is diagnosed by excision of other possible causes of death in addition to macroscopic and microscopic findings [6]. Cold skin erythema in the external examination, Wischnewsky ulcers in the stomach and duodenum and pancreatitis and pancreatic fat necrosis findings in the autopsy are supportive findings for the hypothermia-related deaths [1,[6][7][8]. In addition, there are a number of immunohistochemical, histopathological or biochemical studies on the hypothermia-related mortality diagnosis in the literature [1,6,[8][9][10][11].…”

Lethal hypothermia – a sometimes elusive diagnosis

“…The findings at autopsy can be quite subtle and there is a lack of accord on the necessary features required to make the diagnosis [1][2][3][4]. It is even less clear to what degree hypothermia may contribute to lethal outcomes in the presence of significant underlying organic illnesses.…”

“…Death likely results from a combination of events such as ventricular fibrillation or asystole, initiated or exacerbated by hypoxia, myocardial ischemia, increased circulating catecholamines and electrolyte derangements [1,9,15].…”

“…Externally these features include pink discoloration of the skin over the extensor surfaces of large joints. On internal examination there may be superficial gastric erosions, or Wischnewski spots, vacuolization of renal tubular cells, acute pancreatic inflammation with fat necrosis, fatty change in cells of the heart, liver and kidneys, and skeletal muscle hemorrhage [1,4].…”

“…Wischnewski spots in the gastric mucosa are considered the most reliable marker of hypothermia at post mortem [1,3,[24][25][26]. There is, however, considerable variation in their reported incidence which may be related to the length of exposure to low temperatures, or to idiosyncratic general and gastric mucosal responses to cold stress [3,[27][28][29].…”