Two cases of paradoxical hypothermia in a Sahara desert multi-stage ultramarathon


Submitted: 2 June 2014
Accepted: 13 October 2014
Published: 21 November 2014
Abstract Views: 1091
PDF: 571
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Authors

  • Elizabeth A. Kaufman Department of Surgery, Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, United States.
  • Grant S. Lipman Department of Surgery, Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, United States.
  • Louis J. Sharp Emergency Medicine Residency, Presence Resurrection Medical Center, Chicago, IL; Department of Emergency Medicine, University of Illinois, Chicago, IL, United States.
  • Brian J. Krabak Department of Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Children’s Hospital, Seattle, WA, United States.
Exertional hypothermia in a hot environment, a seemingly contradictory state, is a clinical presentation that has not been previously described in the medical literature. We present two cases of symptomatic hypothermia of 34-35°C (95°F) which resolved with ingestion of calories in otherwise healthy men competing in a multi-stage ultramarathon in the Sahara desert, Egypt 2012 with ambient temperatures of approximately 38-39°C (100- 102°F). Hypothermia is well documented in the medical literature as a presenting sign of hypoglycemia in both conscious and comatose patients. The mechanism by which hypoglycemia contributes to hypothermia is poorly understood, but may represent a compensatory response that reflects a decrease in energy demand during glucose deprivation. Wilderness medicine practitioners at endurance events should be cognizant of hypothermia as a potential presenting sign of hypoglycemia, as it can be empirically treated and rapidly reversed.

Elizabeth A. Kaufman, Department of Surgery, Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
Emergency Medicine, resident.
Grant S. Lipman, Department of Surgery, Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA

Clinical Assistant Professor, Surgery - Emergency Medicine 

Louis J. Sharp, Emergency Medicine Residency, Presence Resurrection Medical Center, Chicago, IL; Department of Emergency Medicine, University of Illinois, Chicago, IL
Clinical Assistant Professor, Emergency Medicine - Wilderness Medicine
Brian J. Krabak, Department of Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Children’s Hospital, Seattle, WA
Clinical Associate Professor, Physical Medicine and Rehabilitation - Sports Medicine and Spine
Kaufman, E. A., Lipman, G. S., Sharp, L. J., & Krabak, B. J. (2014). Two cases of paradoxical hypothermia in a Sahara desert multi-stage ultramarathon. Emergency Care Journal, 10(2). https://doi.org/10.4081/ecj.2014.4279

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