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Elizabeth Adeolu

Cold Exposure: Complications, Treatment, and Prevention

Introduction

Cold exposure refers to being exposed to low environmental temperatures. This can cause physiological stress and, if severe or prolonged, can lead to potentially fatal conditions like frostbite, which refers to localized tissue freezing resulting from prolonged cold exposure; hypothermia, which refers to to a severe drop in core body temperature (<35°C or 95°F) that can be fatal; and cold-induced injuries, such as chilblains (pernio or cold sores), an inflammatory response to cold exposure which causes painful, red, or swollen lesions, especially on extremities, and cold urticaria, an allergic skin reaction to cold exposure characterized by hives and itching (Giesbrecht & Wilkerson, 2006; Olsen, 2024).


Complications

Cold exposure can lead to a variety of complications, ranging from mild to life-threatening (Helge Brändström et al., 2014). Prolonged exposure to cold temperatures can result in hypothermia, potentially causing cardiac arrhythmias, respiratory depression, and even cardiac arrest (Datta & Tipton, 2006). Peripheral tissues are particularly vulnerable, and frostbite can occur, leading to tissue freezing, necrosis, and in severe cases, gangrene, which may necessitate amputation (Golant et al., 2008). Repeated or chronic exposure may cause chilblains and cold-induced urticaria (Ibid., 2006; Ibid., 2024). Additionally, the breakdown of damaged muscle tissue in severe frostbite or hypothermia can result in rhabdomyolysis, contributing to acute kidney injury (Vural et al., 2020). Infections, including sepsis, can develop in frostbite wounds if untreated (Gao et al., 2021).


Treatment Protocols

The treatment protocols for cold-related conditions vary based on the severity and type of exposure (Karkori, 2024). Hypothermia management focuses on rewarming and stabilizing vital functions mild cases benefit from passive rewarming with blankets and warm beverages, while severe cases require active rewarming methods, such as heated IV fluids and external warming devices, alongside cardiac monitoring to prevent arrhythmias (Tveita & Sieck, 2021). Frostbite treatment involves rapid rewarming in warm water (37–39°C), pain management, and careful wound care to address blisters or necrotic tissue, with surgical intervention or amputation reserved for severe cases (Persitz et al., 2022). Chilblains are managed with gradual rewarming, topical corticosteroids for inflammation, and calcium channel blockers like nifedipine to improve circulation in recurrent or severe cases (McIntosh, 2015). For cold-induced urticaria, treatment includes antihistamines to control hives and itching, while severe reactions may require epinephrine and emergency care (Krause et al., 2010).


Prevention

Preventing cold exposure requires proactive measures to protect the body from low temperatures and minimize heat loss. Dressing in layers is crucial, with moisture-wicking inner layers, insulating middle layers, and waterproof, wind-resistant outer layers to shield against the elements (Bhatia et al., 2024). Extremities are especially vulnerable, so gloves, hats, and insulated footwear are essential. Staying dry is critical, as wet clothing accelerates heat loss; waterproof clothing and frequent checks for dampness can help (Bhatia et al., 2024). Consuming high-calorie foods and warm beverages helps sustain body heat, while avoiding alcohol is important, as it impairs thermoregulation (Klous et al., 2024).  Limiting time spent in extreme cold and an awareness of weather conditions and having emergency supplies, like blankets and heating packs, can further prevent cold-related injuries, especially in remote or high-risk environments (Klous et al., 2024). Public education and workplace policies are also vital in reducing cold exposure risks for outdoor workers and vulnerable populations (Conlon et al., 2011).


Conclusion

Cold exposure poses significant risks, including hypothermia, frostbite, and inflammatory or allergic conditions like chilblains and cold-induced urticaria, which can lead to lasting damage if untreated. Prompt and appropriate treatment, such as rewarming, medication, and wound care, is crucial to mitigate complications. Equally important is prevention through protective clothing, limiting exposure, and proper hydration and nutrition. By understanding the dangers of cold exposure and implementing preventive measures, individuals can reduce the risk of cold-related injuries and ensure safer interactions with cold environments. Early recognition and medical intervention remain key to positive outcomes.


References

Bhatia, D., Jaswal, P., & Sinha, S. (2024). A Review of Emerging Technologies and Future Fabrics for Extreme Cold . Textile & Leather Review, 7, 265–291.


Conlon, K. C., Rajkovich, N. B., White-Newsome, J. L., Larsen, L., & O’Neill, M. S. (2011). Preventing cold-related morbidity and mortality in a changing climate. Maturitas, 69(3), 197–202.


Datta, A., & Tipton, M. (2006). Respiratory responses to cold water immersion: neural pathways, interactions, and clinical consequences awake and asleep. Journal of Applied Physiology, 100(6), 2057–2064.


Gao, Y., Wang, F., Zhou, W., & Pan, S. (2021). Research progress in the pathogenic mechanisms and imaging of severe frostbite. European Journal of Radiology, 137, 109605.


Giesbrecht, G., & Wilkerson, J. (2006). Hypothermia, Frostbite, and Other Cold Injuries: Prevention, Survival, Rescue, and Treatment (2nd ed.). The Mountaineers.


Golant, A., Nord, R. M., Paksima, N., & Posner, M. A. (2008). Cold Exposure Injuries to the Extremities. JAAOS - Journal of the American Academy of Orthopaedic Surgeons, 16(12), 704.


Helge Brändström, Johansson, G., Giesbrecht, G. G., Karl-Axel Ängquist, & Haney, M. (2014). Accidental cold-related injury leading to hospitalization in northern Sweden: an eight-year retrospective analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 22(1).


Karkori, F. (2024). Diagnosis and Treatment of Cold Stress Injuries. Synthesis Lectures on Ocean Systems Engineering, 315–339.


Klous, L., Teien, H., Hollis, S., Levels, K., Boonstra, A., Sullivan-Kwantes, W., Haman, F., Castellani, J. W., Catoire, M., & Kingma, B. (2024). Cold weather operations: Preventive strategies in a military context. Temperature, 1–20.


Krause, K., Zuberbier, T., & Maurer, M. (2010). Modern Approaches to the Diagnosis and Treatment of Cold Contact Urticaria. Current Allergy and Asthma Reports, 10(4), 243–249.


McIntosh, I. B. (2015). Chilblains--a pernicious affliction. Podiatry Review, 72(1), 6–9.


Olsen, A. (2024). Extreme Low Temperature Safety. Springer Series on Naval Architecture, Marine Engineering, Shipbuilding and Shipping/Springer Series on Naval Architecture, Marine Engineering, Shipbuildung and Shipping, 473–495.


Persitz, J., Essa, A., Ner, E. B., Assaraf, E., & Avisar, E. (2022). Frostbite of The Extremities – Recognition, Evaluation and Treatment. Injury, 53(10), 3088–3093.


Tveita, T., & Sieck, G. C. (2021). Physiological Impact of Hypothermia: The Good, the Bad and the Ugly. Physiology, 37(2).


Vural, A., Ekiz, M., & Günaydin, M. (2020). A case of acute renal failure requiring emergency hemodialysis due to hypothermia-associated rhabdomyolysis. Journal of Surgery and Medicine, 4(11), 1092–1094. Assessed and Endorsed by the MedReport Medical Review Board



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