Hospital management should include active core rewarming utilizing peritoneal dialysis, arterio-venous shunts, or peripheral rewarming involving torso water immersion. Rewarming blankets are slow but may be the only rewarming devices available. Volume replacement is essential to decrease viscosity and increase cardiac output. Low central venous pressures are advisable early and are increased slowly as there is an indication of the ability to hold fluid in the vascular space. Hyperkalemia is improved by fluid replacement and glucose and insulin infusions.
Sodium bicarbonate is indicated early to begin correction of acidosis.
However, overzealous correction is ill advised. The patient should be kept mildly acidotic throughout the treatment process. Improved ventilation during the resuscitation can improve pH significantly. Antiarrthymic drugs are contraindicated. Excessive early manipulation can result in cardiac arrest.