Physiologic changes and clinical findings by stage of hypothermia

Stage	Core temperature	Selected physiologic changes	Clinical findings
Mild	32 to 35°C (90 to 95°F)	Compensatory shivering	Shivering but conscious
		Increased metabolism	Cyanosis
		Vasoconstriction	Prolonged capillary refill
		Mild tachycardia	Prolonged capillary refill
Moderate	28 to 32°C (82 to 90°F)	Loss of compensatory shivering	Shivering stops
		Decreased cerebral blood flow	Impaired consciousness
		Decreased metabolism	Clumsiness
		Cold diuresis	Confusion or delirium
		Extravasation of fluids	Slurred speech
		Hypovolemia	Decreasing blood pressure
Severe	<28°C (<82°F)	Muscle rigidity without shivering	No shivering, unconscious, vital signs may or may not be present
		Loss of thermoregulation	Muscle rigidity
		Vasodilation	Erythema and edema
		Decreased HR, SV, CO	Stupor or coma
		Decreased cardiac conduction	Absent pulses
		Increased cardiac irritability	Fixed, dilated pupils
		Slowed nerve conduction	Ventricular fibrillation
		Suspended cerebral activity	Asystole

HR: heart rate, SV: stroke volume; CO: cardiac output.
Changes are typical of the hypothermia stage shown, but may vary in the temperature of onset. The degree of hypothermia may be initially estimated from clinical findings, but core body temperature, not clinical findings, should guide management of hypothermia.

Graphic 62978 Version 8.0

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Physiologic changes and clinical findings by stage of hypothermia