The Poison Review

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CASE 41-2009: A 16-YEAR-OLD BOY WITH HYPOTHERMIA AND FROSTBITE Sheridan RL et al. N Eng J Med 31 Dec 2009;361:2654-62.

Extract

This week’s “Case Records” discussion in the New England Journal of Medicinepresents a teenager who was found unconscious and partially unclothed in a snowbank approximately 7 hours after leaving a New Year’s Eve party at which he consumed alcohol.  When brought to the emergency department his rectal temperature was 31.3°C (88.3ºF) and he was not shivering.  On exam, his right foot was encased in ice and both hands were hard and cold. Ethanol level was 117 mg/dL. After systemic rewarming with warm IV fluids and a forced-hot-air blanket, and thawing of distal extremities with a water bath at 40ºC (104ºF), the distal right foot and fingers on both hands remained unperfused.  Thrombolytic therapy was instituted.

Since physiologically this patient had only moderate hypothermia, the discussion of this case does not go into detail about cold-induced cardiovascular instability, or interpretation of vital signs and laboratory results in the presence of severe hypothermia.  However, the discussion of the relatively new concept of treating frostbite with thrombolytics is excellent. There is also a general review of the issue of alcohol abuse in adolescents.