Respiratory failure and spontaneous hypoglycemia during noninvasive rewarming from 24.7°C (76.5°F) core body temperature after prolonged avalanche burial

Ann Emerg Med. 2012 Aug;60(2):193-6. doi: 10.1016/j.annemergmed.2011.11.015. Epub 2011 Dec 9.


Clinical reports on management and rewarming complications after prolonged avalanche burial are not common. We present a case of an unreported combination of respiratory failure and unexpected spontaneous hypoglycemia during noninvasive rewarming from severe hypothermia. We collected anecdotal observations in a 42-year-old, previously healthy, male backcountry skier admitted to the ICU at a tertiary care center after 2 hours 7 minutes of complete avalanche burial, who presented with a patent airway and a core body temperature of 25.0°C (77.0°F) on extrication. There was no decrease in core body temperature during transport (from 25.0°C [77.0°F] to 24.7°C [76.5°F]). Atrial fibrillation occurred during active noninvasive external rewarming (to 37.0°C [98.6°F] during 5 hours), followed by pulmonary edema and respiratory failure (SaO(2) 73% and PaO(2)/FIO(2) 161 mm Hg), which resolved with endotracheal intubation and continuous positive end-respiratory pressure. Moreover, a marked spontaneous glycemic imbalance (from 22.2 to 1.4 mmol/L) was observed. Despite a possible favorable outcome, clinicians should be prepared to identify and treat severe respiratory problems and spontaneous hypoglycemia during noninvasive rewarming of severely hypothermic avalanche victims.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Avalanches*
  • Body Temperature
  • Continuous Positive Airway Pressure
  • Disasters*
  • Emergency Medical Services
  • Humans
  • Hypoglycemia / etiology*
  • Hypothermia / complications
  • Hypothermia / therapy*
  • Intensive Care Units
  • Intubation, Intratracheal
  • Male
  • Pulmonary Edema / etiology
  • Respiratory Insufficiency / etiology*
  • Rewarming / adverse effects*