Research Day

Hypothermia Deaths And Altered Mental Status

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INTRODUCTION: The Midwestern United States is no stranger to sub-freezing winters. But while most people who have access to shelter would be apt to escape the cold to find solace inside, some who are cognitively impaired may find themselves unable to illicit this natural instinct. 5

PURPOSE: We report on nine hypothermia-related deaths wherein some form of altered mental status contributed to death.

MATERIALS: Cases were non-randomly selected from the forensic pathology files of one of the authors (JP).

RESULTS: Nine cases of death from hypothermia are presented. Based on review of the scene investigation, autopsy results, and previous medical records, each case involved some form of impaired judgment, including dementia, physiologic hormone or electrolyte imbalance, or drug use or abuse.2,3,5 While the situations for each case differed, classic morphologic stigmata of hypothermia, including gastric Wishnewsky spots and "frost erythema" were seen in a majority of cases.7 Paradoxical undressing was also common.7

DISCUSSION: Although not the only risk factor, altered mental status is a well-known risk factor for hypothermia. Common causes of altered mental status include degenerative neurologic disorders, including various forms of dementia, as well as substance abuse.2,3,5 It should also be noted that alcohol abuse and degenerative neurologic disorders frequently have coexisting physical manifestations; such comorbidities may have also played a contributory role in these deaths.

CONCLUSION: By highlighting the inherent risks of hypothermia related to altered mental status, preventive strategies may be developed and implemented in order to reduce the mortality within specific populations. 1, 2, 3

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