Skip to main content
PMC home page
British Medical Journal logoLink to British Medical Journal
. 1973 Dec 29;4(5895):757–761. doi: 10.1136/bmj.4.5895.757

Acute Pancreatitis and Diabetic Ketoacidosis in Accidental Hypothermia and Hypothermic Myxoedema

D Maclean, J Murison, P D Griffiths
PMCID: PMC1587988  PMID: 4128001

Abstract

Serial serum amylase and blood glucose levels were measured in 68 hypothermic (rectal temperature 35°C or less) patients, including 15 who had hypothermic myxoedema (serum protein bound iodine 3·5 μg/100 ml or less). Raised amylase levels were found in 34 patients and probably reflected a mild acute pancreatitis. The high amylase levels correlated with low arterial PO2 levels and significantly with high arterial PCO2 levels and the base deficit but not with the severity or duration of the hypothermia. The acute pancreatitis does not explain why hypothermic patients with myxoedema have a poorer prognosis than those who are euthyroid. The pancreatitis occasionally contributed to the development, sometimes delayed, of diabetic ketoacidosis, blood glucose levels of over 120 mg/100 ml being found in 20 patients. There was a significant correlation between the raised serum amylase levels and the hyperglycaemia. Hypoglycaemia, sometimes profound, was found in 12 patients.

Full text

PDF
757

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ADOLPH E. F., LAWROW J. W. Oxygen consumptions of hypothermic rats and acclimatization to cold. Am J Physiol. 1950 Jun 1;161(3):359–373. doi: 10.1152/ajplegacy.1950.161.3.359. [DOI] [PubMed] [Google Scholar]
  2. Baum D., Porte D., Jr Alpha-adrenergic inhibition of immunoreactive insulin release during deep hypothermia. Am J Physiol. 1971 Jul;221(1):303–311. doi: 10.1152/ajplegacy.1971.221.1.303. [DOI] [PubMed] [Google Scholar]
  3. CALLAGHAN P. B., LISTER J., PATON B. C., SWAN H. Effect of varying carbon dioxide tensions on the oxyhemoglobin dissociation curves under hypothermic conditions. Ann Surg. 1961 Dec;154:903–910. [PMC free article] [PubMed] [Google Scholar]
  4. CLOSE J. R., STREET H. V. An ultra-micro method for determination of amylase activity in blood serum. Clin Chim Acta. 1958 Sep;3(5):476–479. doi: 10.1016/0009-8981(58)90041-x. [DOI] [PubMed] [Google Scholar]
  5. Curry D. L., Curry K. P. Hypothermia and insulin secretion. Endocrinology. 1970 Oct;87(4):750–755. doi: 10.1210/endo-87-4-750. [DOI] [PubMed] [Google Scholar]
  6. DONNELLY C., FROBESE A. S., STONE H. H. The effect of lowered body temperature on the cerebral hemodynamics and metabolism of man. Surg Gynecol Obstet. 1956 Sep;103(3):313–317. [PubMed] [Google Scholar]
  7. DUCKWORTH W. C., COOPER B. C. ACCIDENTAL HYPOTHERMIA IN THE BANTU. S Afr Med J. 1964 May 2;38:295–298. [PubMed] [Google Scholar]
  8. DUGUID H., SIMPSON R. G., STOWERS J. M. Accidental hypothermia. Lancet. 1961 Dec 2;2(7214):1213–1219. doi: 10.1016/s0140-6736(61)92588-0. [DOI] [PubMed] [Google Scholar]
  9. EDWARDS W. S., TULUY S., REBER W. E., SIEGEL A., BING R. J. Coronary blood flow and myocardial metabolism in hypothermia. Ann Surg. 1954 Mar;139(3):275–281. doi: 10.1097/00000658-195403000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. EMSLIE-SMITH D. Accidental hypotherimia; a common condition with a pathognomic electrocardiogram. Lancet. 1958 Sep 6;2(7045):492–495. doi: 10.1016/s0140-6736(58)91283-2. [DOI] [PubMed] [Google Scholar]
  11. FRUEHAN A. E. Accidental hypothermia. Report of eight cases of subnormal body temperature due to exposure. Arch Intern Med. 1960 Aug;106:218–229. doi: 10.1001/archinte.1960.03820020058009. [DOI] [PubMed] [Google Scholar]
  12. HORVATH S. M., HUTT B. K., SPURR G. B., STEVENS G. E. Some metabolic responses of dogs having low body temperature. Science. 1953 Jul 24;118(3056):100–101. doi: 10.1126/science.118.3056.100. [DOI] [PubMed] [Google Scholar]
  13. Jones R. H., Bourdillon R. E., Finn R., Martindale K. Hypothermia associated with pneumonia and acidosis. Postgrad Med J. 1966 Apr;42(486):273–275. doi: 10.1136/pgmj.42.486.273. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Knight A. H., Williams D. N., Ellis G., Goldberg D. M. Significance of hyperamylasaemia and abdominal pain in diabetic ketoacidosis. Br Med J. 1973 Jul 21;3(5872):128–131. doi: 10.1136/bmj.3.5872.128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. LANGE K., WEINER D., GOLD M. M. A. Studies on the mechanism of cardiac injury in experimental hypothermia. Ann Intern Med. 1949 Dec;31(6):989–1002. doi: 10.7326/0003-4819-31-6-989. [DOI] [PubMed] [Google Scholar]
  16. LAUFMAN H. Profound accidental hypothermia. J Am Med Assoc. 1951 Nov 24;147(13):1201–1212. doi: 10.1001/jama.1951.03670300015004. [DOI] [PubMed] [Google Scholar]
  17. LOUGHEED W. M., SWEET W. H., WHITE J. C., BREWSTER W. R. The use of hypothermia in surgical treatment of cerebral vascular lesions; a preliminary report. J Neurosurg. 1955 May;12(3):240–255. doi: 10.3171/jns.1955.12.3.0240. [DOI] [PubMed] [Google Scholar]
  18. MURPHY E., FAUL P. J. Accidental hypothermia in the elderly. J Ir Med Assoc. 1963 Jul;53:4–8. [PubMed] [Google Scholar]
  19. Maclean D., Griffiths P. D., Emslie-Smith D. Serum-enzymes in relation to electrocardiographic changes in accidental hypothermia. Lancet. 1968 Dec 14;2(7581):1266–1270. doi: 10.1016/s0140-6736(68)91761-3. [DOI] [PubMed] [Google Scholar]
  20. Maclean D., Taig D. R., Emslie-Smith D. Achilles tendon reflex in accidental hypothermia and hypothermic myxoedema. Br Med J. 1973 Apr 14;2(5858):87–90. doi: 10.1136/bmj.2.5858.87. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. McKean W. I., Dixon S. R., Gwynne J. F., Irvine R. O. Renal failure after accidental hypothermia. Br Med J. 1970 May 23;1(5707):463–464. doi: 10.1136/bmj.2.5707.463. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Michenfelder J. D., Uihlein A., Daw E. F., Theye R. A. Moderate hypothermia in man: haemodynamic and metabolic effects. Br J Anaesth. 1965 Oct;37(10):738–745. doi: 10.1093/bja/37.10.738. [DOI] [PubMed] [Google Scholar]
  23. PRESCOTT L. F., PEARD M. C., WALLACE I. R. Accidental hypothermia. A common condition. Br Med J. 1962 Nov 24;2(5316):1367–1370. doi: 10.1136/bmj.2.5316.1367. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. READ A. E., EMSLIE-SMITH D., GOUGH K. R., HOLMES R. Pancreatitis and accidental hypothermia. Lancet. 1961 Dec 2;2(7214):1219–1221. doi: 10.1016/s0140-6736(61)92589-2. [DOI] [PubMed] [Google Scholar]
  25. ROE P. F. ACCIDENTAL HYPOTHERMIA. Ir J Med Sci. 1963 Oct;454:459–463. doi: 10.1007/BF02951123. [DOI] [PubMed] [Google Scholar]
  26. STREET H. V., CLOSE J. R. Determination of amylase activity in biological fluids. Clin Chim Acta. 1956 May-Jun;1(3):256–268. doi: 10.1016/0009-8981(56)90072-9. [DOI] [PubMed] [Google Scholar]
  27. Soler N. G., Bennett M. A., FitzGerald M. G., Malins J. M. Intensive care in the management of diabetic ketoacidosis. Lancet. 1973 May 5;1(7810):951–954. doi: 10.1016/s0140-6736(73)91597-3. [DOI] [PubMed] [Google Scholar]
  28. Sprunt J. G., Maclean D., Browning M. C. Plasma-corticosteroid levels in accidental hypothermia. Lancet. 1970 Feb 14;1(7642):324–326. doi: 10.1016/s0140-6736(70)90702-6. [DOI] [PubMed] [Google Scholar]
  29. WHITTAKER S. R., WHITEHEAD T. P. The diagnosis and treatment of hypopituitarism. Br Med J. 1954 Jul 31;2(4882):265–269. doi: 10.1136/bmj.2.4882.265. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. WYNN V. The metabolism of fructose during hypothermia in man. Clin Sci. 1956 May;15(2):297–304. [PubMed] [Google Scholar]

Articles from British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES