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Hypothermia and hyperthermia

Hypothermia and hyperthermia deaths Hypothermia: Core body temperature drops below 35 degrees Centigrade. Deaths from exposure occur through heat loss from a mixture of radiation, convection, conduction, respiration and evaporation. In some patients there may be an underlying medical cause (such as thyroid or pituitary dysfunction). It may be associated with immobile or demented patients. Hypothermia causes depression of the cardiovascular and nervous systems, the latter causing cognitive impairment. Generally, the elderly, children and trauma patients are susceptible to hypothermia. Findings at autopsy: Hemorrhagic gastric lesions (Wischnewsky spots), infarction of small bowel, frostbite, and pinkish discoloration over the large joints. There may be paradoxical undressing – Individuals are typically found partially clothed or naked in a setting of lethal hypothermia. (The individuals apparently - incorrectly - perceive warmth and shed their clothing). Rachel de Beer (1831–1843) (sometimes known by the diminutive form, Racheltjie) was an Afrikaner heroine, who gave her life in order to save that of her brother, Dirkie de Beer. She was the daughter of George Stephanus de Beer. The phenomenon of ‘hide-and-die syndrome’ describes the finding of a body that appears to be hidden, for example, under furniture or in the corner of a room, often surrounded by disturbed furniture, clothes or other artefacts. In these cases, the individual has placed themselves in the location. It is thought that this phenomenon reflects a terminal primitive ‘self-protective’ behavior and may be more commonly observed where there is a slow decrease in core body temperature. It may be difficult to differentiate between ‘hide-and-die syndrome’ and deliberate concealment by another. Hyperthermia: Core body temperature goes greater than 40 degrees Centigrade. Heat is no longer dissipated, leading to excessive heat retention. May be associated with those who took certain drugs (some anti-psychotics, cocaine and amphetamines). May also occur with hyperthyroidism. May occur in those resisting restraint. Typically occurs in high-ambient temperatures (heat stroke, exertional heat stroke, and non-exertional heat stroke). May occur in children trapped in hot cars. Exertional heat illness is recognized within military training programs. Autopsy findings are non-specific but may include petechial hemorrhages of serosal membranes and lung congestion as well as features in keeping with ‘shock’ and multiple organ failure, specifically in those who survived a short period of time, if resuscitative measures were ineffective. References: Jason Payne-James and Richard Jones. Simpson’s Forensic Medicine. Fourteenth Edition. CRC Press. 2020. Pages 180 – 187. https://en.wikipedia.org/wiki/Rachelt...