Low Body Temperature (Hypothermia)

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A Golden Retriever struggles to get out of the cold water.

Low body temperature (hypothermia)
Hypothermia is a drop in the body core temperature below the physiological range, e.g., due to cold, wetness, shock, or anesthesia. It leads to a slower heartbeat, weakness, shivering to unconsciousness. Severe hypothermia is life-threatening and must be treated immediately.

Hypothermia, colloquially also referred to as low body temperature, is a pathophysiological condition in which the body core temperature drops below the normal range. In dogs, the normal body temperature is between 37.5 °C and 39.0 °C, in cats between 38.0 °C and 39.5 °C. Hypothermia is said to occur when the body temperature falls below 37.5 °C in the dog and below 38.0 °C in the cat. The severity of hypothermia is divided into three grades: mild hypothermia (35–37 °C), moderate hypothermia (32–35 °C), and severe hypothermia (below 32 °C). At temperatures below 28 °C, there is an acute danger to life.

Temperature regulation in mammals is carried out via the thermoregulatory center in the hypothalamus. This controls various physiological mechanisms for heat production and maintenance. Dogs and cats can regulate their body temperature through muscle shivering, vasoconstriction of peripheral blood vessels, and metabolic adjustments. Compared to humans, however, they have a higher risk of hypothermia due to their lower body mass and, in some breeds, due to a more unfavorable ratio of body surface area to body volume.

Causes

Low body temperature is when the body temperature drops below 36 degrees Celsius.
This can be caused by a cold ambient temperature, so that the body is no longer able to maintain its normal body temperature through its own heat generation. This can occur especially when staying in cold water (Fig.), in anesthetized animals, or in cases of severe dehydration.

Supplement

The causes of hypothermia in dogs and cats are varied and can be divided into environmental, medical, and iatrogenic factors:

Environmental factors include prolonged exposure to low temperatures, primarily in conjunction with wetness or wind. Staying in cold water is particularly dangerous, as water dissipates body heat about 25 times faster than air. Breaking through ice can also lead to life-threatening hypothermia within a very short time.

Medical causes include severe systemic diseases such as shock, sepsis, severe metabolic disorders (e.g., hypoglycemia, hypothyroidism), poisoning, or brain damage that affects the thermoregulatory center. Dehydration can also lead to a reduced ability to regulate heat.

Iatrogenic hypothermia often occurs during surgical procedures. The effect of anesthetics impairs thermoregulation. In addition, open body cavities, cold infusion solutions, and the use of disinfectants lead to increased heat loss.

Very young or old animals, animals with low body weight, short-haired breeds, and animals with pre-existing conditions, especially those affecting the metabolism or cardiovascular system, are particularly at risk.

Symptoms

Low body temperature (hypothermia) in dogs and cats

Typical Symptoms:

  • Shivering, feeling cold, stiff gait, lethargy
  • Pale mucous membranes, slow heartbeat possible
  • Slowed reactions, weakness

Alarm signs:

  • No more shivering (exhaustion), apathy to unconsciousness
  • Decrease in heart rate, very slow pulse, cardiac arrhythmia, cold extremities
  • Respiratory depression, reduced, shallow breathing
  • Drowsiness, cardiovascular collapse, unconsciousness
  • Young animals: rapid decompensation

Escalation/course:

  • Transition from shivering → “silent” hypothermia = significant deterioration
  • Rewarming can make the circulation unstable (afterdrop risk)
  • Hours: coagulation and metabolic disorders possible

 

The clinical signs of hypothermia develop progressively with decreasing body temperature and vary depending on the severity. In mild hypothermia (35–37 °C), the animals initially show muscle shivering as a compensation mechanism for heat production. The animals appear restless, seek out warm places, and huddle together to reduce body surface area. The peripheral parts of the body, such as the ears, paws, and tail, feel cool.

In moderate hypothermia (32–35 °C), the shivering subsides as energy reserves are depleted. The animals become increasingly lethargic and show neurological symptoms such as coordination disorders and decreased reflexes. The heart rate decreases, the pulse becomes weaker, and breathing slows. The mucous membranes appear pale or bluish due to peripheral vasoconstriction and reduced oxygen supply to the tissue.

Severe hypothermia (below 32 °C) leads to marked clouding of consciousness up to coma. The muscles become stiff, the pupils hardly react to light. The heart rate drops drastically, cardiac arrhythmia occurs, and ventricular fibrillation can occur. Breathing becomes shallow and irregular. At this stage, there is an acute danger to life, and death occurs without immediate treatment.

It is particularly problematic that hypothermic animals can be in a seemingly lifeless state, although there are still signs of life. Therefore, the principle applies: “A hypothermic animal is only dead when it is warm and dead.”

First Aid

  1. Bring your pet to a warm room.
  2. If this is not possible, protect it from wind and further cooling by wrapping it in a blanket or the like.
  3. Dry the coat.
  4. Use a heating blanket to warm up.
  5. When using a hot water bottle or heating pad, make sure it is not too hot.
  6. Do not warm your animal up too quickly, e.g., with a radiant heater or a hot bath.
  7. Do not massage your animal.
  8. Offer warm water or broth to drink. But do not force-feed any drinks.

If your pet requires a prolonged operation under general anesthesia, a drop in body temperature may occur.
After surgery, leave your pet with the vet for monitoring until your pet is fully conscious. By then, the body temperature will also have normalized.
If hypothermia is due to fluid deficiency (dehydration), an underlying disease requiring treatment, such as Vomiting or Diarrhea, is present.
Take your pet to a vet.

Diagnosis

The diagnosis of hypothermia is primarily based on measuring the body temperature using a rectal thermometer. It should be noted that commercially available thermometers often only measure up to 34 °C or 32 °C; special thermometers are required for lower temperatures. During the clinical examination, vital functions such as heart rate, respiratory rate, capillary refill time (CRT), and mucous membrane color are also recorded.

Further investigations are useful to assess the severity and possible complications. A blood count can provide information on infections or inflammatory conditions that may have contributed to hypothermia. Blood gas analyses show disorders in the acid-base balance and in the oxygen supply. Electrolyte determinations are important because hypothermia can lead to electrolyte shifts. An ECG is used to detect cardiac arrhythmia, which often occurs in severe hypothermia.

In unconscious animals with an unclear cause of hypothermia, imaging procedures such as X-ray, ultrasound, or CT may be necessary to rule out underlying diseases. The diagnosis should always include the distinction between primary (environmentally related) and secondary (disease-related) hypothermia, as this has implications for therapy and prognosis.

Further veterinary measures

A venous access and securing breathing are the first measures.
Rewarming must be gradual, otherwise there is a risk of ventricular fibrillation. Adequate fluid therapy with pre-warmed infusion solutions counteracts this.
The further procedure differs depending on the degree of hypothermia and the other initial situation.
In the case of very severe hypothermia (< 27 ºC), ventricular fibrillation or cardiac arrest can occur, so that cardiac massage becomes necessary. Defibrillation should only be performed when a body temperature of at least 30 ºC has been reached. Supplements The treatment of hypothermia depends on the severity and the accompanying circumstances. The basic principle is controlled, slow rewarming to avoid dangerous complications such as the afterdrop phenomenon (further drop in core temperature due to backflow of cold blood from the periphery) or reperfusion damage. In mild hypothermia (35–37 °C), passive warming measures are often sufficient: the animal is brought into a warm room, wrapped in pre-warmed blankets, and protected from drafts. Wet fur should be dried carefully. Warm, sweetened liquids can be offered, provided the animal is conscious and able to swallow. Moderate hypothermia (32–35 °C) additionally requires active external heat supply through heating mats, hot water bottles, or heating pads, which should be wrapped with towels to avoid direct contact. Warming should begin on the torso, not on the extremities, to minimize the backflow of cold blood to the heart. Intravenous fluid therapy with infusion solutions warmed to body temperature supports circulatory stabilization. In severe hypothermia (below 32 °C), intensive care is essential. In addition to the measures mentioned, active core warming techniques are used, such as rinsing body cavities with warm liquids or extracorporeal warming procedures. Rewarming should be done at a rate of 0.5–2 °C per hour. Continuous monitoring of vital functions is necessary, as cardiac arrhythmia, electrolyte shifts, and circulatory instability can occur during the warming phase. In addition, oxygen administration, glucose infusions for hypoglycemia, and in severe cases also drugs for circulatory stabilization may be necessary. In the event of cardiac arrest, cardiopulmonary resuscitation (CPR) is performed, whereby it should be noted that defibrillation is only effective in severely hypothermic animals at a body temperature above 30 °C.

Prognosis and aftercare

The prognosis for hypothermia depends largely on the severity, the duration of hypothermia, and any accompanying diseases. In mild to moderate hypothermia without complications, the prognosis is good to very good with timely treatment. Animals usually recover completely without consequential damage.

In severe hypothermia (below 32 °C), the prognosis deteriorates significantly. Complications such as cardiac arrhythmia, coagulation disorders, renal failure, or brain damage can occur. Nevertheless, successful resuscitations have been documented even at very low body temperatures, especially in young, previously healthy animals.

Aftercare includes careful monitoring of vital functions and body temperature over 24–48 hours, as relapses can occur. Regular checks of kidney function, electrolyte balance, and blood count are recommended to detect consequential damage early. In animals that have survived severe hypothermia, neurological examinations should be performed to assess possible brain damage.

Preventive measures to avoid renewed hypothermia must be discussed with the owners. These include adequate weather protection, adaptation of activities in cold weather, and special precautions for at-risk patients such as old or sick animals.

Summary

Hypothermia in dogs and cats is a potentially life-threatening condition characterized by a drop in body temperature below the physiological normal range. It can be caused by environmental influences, underlying diseases, or iatrogenic factors. Very young or old animals, small breeds, and animals with pre-existing conditions are particularly at risk.

The clinical symptoms develop progressively with decreasing body temperature and range from muscle shivering and restlessness in mild hypothermia to unconsciousness, severe cardiac arrhythmia, and respiratory arrest in severe hypothermia. The diagnosis is made primarily by measuring body temperature and clinical examination, supplemented by further diagnostics to assess complications and underlying diseases.

The therapy is based on the principle of controlled, slow rewarming, adapted to the severity of hypothermia. In severe hypothermia, intensive care with continuous monitoring of vital functions is essential. The prognosis is good for mild to moderate hypothermia but worsens with increasing severity and duration of hypothermia.

The occurrence of hypothermia can be prevented in many cases by preventive measures such as adequate weather protection, adaptation of activities in cold weather, and special caution in at-risk patients.

Outlook on current research

Research in the field of hypothermia in small animals is currently focused on several promising areas. New findings on therapeutic hypothermia show that controlled, mild hypothermia after certain emergency situations such as cardiac arrest or traumatic brain injury can have neuroprotective effects. This technique, which is already established in humans, is now being adapted for veterinary use.

Innovative heating systems for the perioperative phase are being developed to minimize the frequently occurring iatrogenic hypothermia during surgical procedures. These include improved heating pads with precise temperature control, warm air blowers, and special insulation materials that more effectively retain body heat.

In the field of intensive care medicine, new protocols for the treatment of severe hypothermia are being explored, including optimized rewarming strategies and pharmacological approaches to minimize reperfusion damage. The development of portable devices for extracorporeal warming could also find application in veterinary medicine in the future.

Molecular biological studies are investigating the cellular mechanisms of cold adaptation and cold damage, which could lead to new therapeutic approaches. Biomarkers for the early detection of organ damage after hypothermia are being evaluated to improve prognosis assessment and enable targeted therapies.

Frequently asked questions (FAQs)

  1. From what temperature do we speak of hypothermia in dogs and cats?
    In dogs, hypothermia is present when the body temperature falls below 37.5 °C, and in cats below 38.0 °C.
  2. Which animals are particularly at risk for hypothermia?
    Very young and old animals, small breeds with an unfavorable surface-to-volume ratio, short-haired breeds, underweight animals, and animals with pre-existing conditions such as hypothyroidism or heart failure are particularly at risk.
  3. How can I measure my animal’s body temperature correctly?
    The measurement is carried out rectally with a digital thermometer, which should be left in the anus for at least one minute. The thermometer should be pre-coated with Vaseline or a water-soluble lubricant.
  4. Is shivering in the cold always a sign of hypothermia?
    Not necessarily. Shivering is initially a normal compensation mechanism for heat production. However, if the shivering persists or is accompanied by other symptoms such as lethargy, this may indicate hypothermia.
  5. Can I give my hypothermic animal alcohol to warm it up?
    No, definitely not! Alcohol dilates the peripheral blood vessels and can lead to further heat loss. In addition, alcohol is toxic to animals.
  6. Why shouldn’t a hypothermic animal be warmed up too quickly?
    Warming up too quickly can lead to the “afterdrop” phenomenon, in which cold blood flows back from the periphery to the heart and further lowers the core temperature. In addition, reperfusion damage and dangerous cardiac arrhythmia can occur.
  7. Can hypothermia cause long-term damage?
    Yes, especially in severe hypothermia, organ damage to the kidneys, liver, brain, and other organs can occur. Neurological deficits can also remain as consequential damage.
  8. How can I prevent hypothermia in my pet?
    Through adequate weather protection, adaptation of walks in cold weather, use of dog clothing in sensitive breeds, immediate drying after water contact, and special caution in at-risk patients.
  9. Is hypothermia dangerous during anesthesia?
    Yes, perioperative hypothermia can lead to prolonged recovery times, increased infection risk, coagulation disorders, and Cardiac arrhythmia. Therefore, modern veterinary medicine uses warming systems during operations.
  10. When do I need to take my hypothermic animal to the vet?
    A veterinarian should be consulted for any suspected hypothermia. This is urgently necessary for body temperatures below 35°C, in case of clouding of consciousness, breathing problems, or if the animal does not respond to simple warming measures.

Literature

  • Tischer, A.: The effect of heat and moisture exchangers on intraoperative temperature development in dogs and cats. Inaugural Dissertation FU Berlin, Berlin 2010
  • Löwe, G. and Löwe, O. (2021). Emergencies in dogs and cats – A veterinary Guide. Kynos-Verlag. 208 pp.
  • Brodeur A, Wright A, Cortes Y. Hypothermia and targeted temperature management in cats and dogs. Journal of Veterinary Emergency and Critical Care. 2017;27(2):151-163.
  • Oncken AK, Kirby R, Rudloff E. Hypothermia in critically ill dogs and cats. Compendium on Continuing Education for the Practicing Veterinarian. 2021;23(6):506-521.
  • Silverstein DC, Hopper K. Small Animal Critical Care Medicine. 2nd ed. St. Louis, MO: Elsevier; 2022.
  • Mazzaferro EM. Perioperative hypothermia in small animals. Veterinary Clinics of North America: Small Animal Practice. 2023;53(1):95-107.
  • Plunkett SJ, McMichael M. Emergency procedures for the small animal veterinarian. 4th ed. London: Elsevier; 2023.