Early Use of Hemodialysis for Active Rewarming in Severe Hypothermia: A Case Report and Review of Literature

Figures & data

Figure 1. EKG with hypothermia prior to rewarming.

Note: Osborn waves indicated by arrows.

Figure 2. Temperature changes with different methods of rewarming.

Figure 3. EKG after rewarming with hemodialysis showing resolution of Osborn waves.

Table 1. Review of management of hypothermia prior to initiating hemodialysis in published case reports.

Case reports	Age (years)	Presence of renal failure	Lowest body temp (°C)	Initial rewarming strategy	Rewarming rate (°C/h off HD)	Time before initiation of HD in hours
Hernandez et al.^16	34	Yes	27.0	Warmed IVF	NS	NS
Carr et al.^17	35	No	23.9	Warmed blankets, warm inspired air, warmed IVF	NS	<1
Sultan et al.^18	65	No	26.0	Warmed blankets, warm inspired air, warmed IVF, bladder irrigation	0.5	>7
Owda and Osama^19	73	Yes	24.9	Peritoneal dialysis	1.0	6
Yokoyama et al.^20	71	Yes	30.0	Heated blankets, warmed IVF	NS	NS
Our case	45	No	26.2	Warmed blankets, warm inspired air, warmed IVF	1.06	4.5

Note: IVF, intravenous fluid; HD, hemodialysis; temp, temperature; NS, not specified.

Table 2. Review of management of hypothermia after initiating hemodialysis in published case reports.

Case reports	Rewarming rate (°C/h on HD)	Temp dialysate bath (°C)	Hours on HD	Hypotension during HD requiring pressors	Outcome
Hernandez et al.^16	2.15	40.0	4.0	NS	Survived
Carr et al.^17	2.8	NS	7.0	Yes	Expired
Sultan et al.^18	2.4	Initially 36.0, decreased to 35.0 after 0.5 h, then increased back to 36.0	2.0	Yes	Survived
Owda and Osama^19	1.9	NS	3.5	NS	Survived
Yokoyama et al.^20	N/A	NS	NS	NS	Survived
Our case	3.3	37.0	4.0	Yes	Survived

Note: HD, hemodialysis; temp, temperature; NS, not specified.

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