With worsening, the pulse gets weaker and slower, shivering ceases, respirations are slow and shallow and the patient becomes very pale. Confusion worsens sometimes to delirium and muscular rigidity develops. Further deterioration leads to stupor or coma. The clinical context of the hypothermia is often the best clue to the underlying cause. Environmental exposure to cold or a history or findings or a high cervical cord lesion, polyneuropathy, hypothyroidism are usually obvious.
Evoked responses are less affected.
This effect is modified by anesthesia and carbon dioxide concentration. Serum potassium should be checked, as hyperkalemia is a common accompaniment. A coagulation screen should probably be performed. Management Prevention of hypothermia involves dressing warmly in cold weather, avoiding adverse weather, maintaining adequate nutrition, maintaining adequate indoor temperatures and regular checks on elderly patients in cold weather. Patients with quadriplegia, who cannot conserve heat by vasoconstriction or increase heat production by shivering, are especially at risk of hypothermia if exposed to cold environmental temperatures.