Pathpphysiology of body temperature

regulation

Prof. J. Hanáček
Thermoregulation of human body
Normal body temperature regulation

It is achieved by activities in 3 subsystems:

1) Thermoafferent system
2) Integrating system
3) Effector system

1) Thermoafferent system:
 Thermoreceptors – skin, hypothalamus, spinal cord...
 afferent n. fibres  rostral brain stem  thalamic nuclei and
hypothalamus  somatosensory cortex
Density of thermoreceptors: skin in face, neck and chest contain 5-times
more theroreceptors than rest of body
2) Integrating system
- it is present at several levels of the CNS (mesencephalon, medulla
oblongata ...)
- hypothalamus is the center for thermoregulation

3) Effector system
- autonomic nerve system is involved – vasodilatation,sweating
vasoconstriction, shivering
- nerve pathways from dorsal hypothalamus: control shivering nerve
tract emerges and connect to extrapyramidal motor tract  shivering
Disturbancies of thermoregulatory sweating

 Generalized anhydrosis – resulting in hyperthermia

– idiopathic
– due to lesions in hypothalamus or in the spinal cord

 Segmental anhydrosis – only local disturbance of sweating

– lesion of sympathetic trunk
– anhydrosis in the area of sensory deficit – in nerve plexus lesions,
– isolated or combined
neuropathies
Central hyperthermia

Causes: - hypothalamic lesions (infarction, hemorrhage, tumor,

trauma, encephalitis)
- intoxication(anticholinergic and sympatho mimetic drugs,
salicylates, amphetamines, cocaine)
- acute spinal cord transection above T3-4
- delirium, catatonia
- malignant neuroleptic sy.(caused by skeletal muscle rigidity
from treatment with neuroleptic medications (e.g., antipsychotics,
antidepressants, antiemetics).
- malignant hyperhermia (rapid and massive skeletal muscle
contraction from exposure to anesthesia)
- dehydration, heat stroke, generaised tetanus
Another mechanisms involved in damage of tissue
in hypethermia:

- When blood flow is diverted to the skin, reduced perfusion of

the intestines and other viscera can result in ischemia,
endotoxemia, and oxidative stress
- Excessively high tissue temperatures (heat shock >41° C, 105.8° F)
can produce direct tissue injury

- Heat shock, ischemia, and systemic inflammatory responses can

result in cellular dysfunction, disseminated intravascular
coagulation, and multiorgan dysfunction syndrome

- Reduced cerebral blood flow, combined with abnormal local

metabolism and coagulopathy, can lead to dysfunction of
the central nervous system
Sympoms and signs of heat illness (hyperthermia)

Minor intensity of heat illness - symptoms and signs

- Miliaria rubra (heat rash) - results from occlusion of eccrine

sweat gland ducts

- Heat syncope (fainting) - caused by temporary circulatory

insufficienc as a result of pooling of blood in the peripheral veins

- Heat cramps (skeletal muscles cramps) - occur during and after

intense exercise and are believed to result from excessive loss
of sodium in sweat
Serious heat illness – sympoms and signs

- Heat exhaustion - a mild to moderate illness characterized

by an inability to sustain cardiac output with moderate
(>38.5° C, 101° F) to high (>40° C, 104° F) body temperatures
(hot skin and dehydration)

- Heat injury - a moderate to severe illness characterized by organ

(e.g. liver, renal) and tissue (e.g. gut, muscle) injury with high
body temperatures, usually but not always greater than 40° C
(104° F)

- Heat stroke - a severe illness characterized by central nervous

system dysfunction with high body temperatures, usually but
not always greater than 40° C (104° F)
Cold injury

 Cold injuries are classified as hypothermia and peripheral cold

injuries
- Hypothermia - whole body cooling
- Peripheral cold injuries - localized to the extremities and
exposed skin:
- nonfreezing (chilblain, trench foot)
- freezing (frostbite)

Both hypothermia and peripheral cold injuries often occur

simultaneously
Cold exposure elicits:

- peripheral vasoconstriction to reduce heat transfer between the body's core

and shell (skin, subcutaneous fat)

- underlying tissues (e.g., muscle) constrict to thicken the isolative shell while
reducing the body core area

- this vasoconstrictor response defends core temperature, but at the expense

of declining peripheral tissue temperatures, which contribute to peripheral cold
injuries

- hypothermia depresses enzymatic activity, interferes with physiologic functions

(e.g., clotting, respiration, cardiac conduction and rhythm), impairs expression
of cytokines, and can induce cellular injury and death
Symptoms and signs of cold injury

Hypothermia - a core temperature below 95° F (35° C), and clinical

manifestations are related to the core temperature
achieved. The classic J wave on ECG
appears at a core temperature
below about 93° F

 Chilblain - appears as localized inflammatory lesions of the skin

that most often involve the dorsal surface of fingers, but
the ears, face, and exposed shins are common areas
“Trench foot”- caused by prolonged cold-wet (e.g., wet socks or gloves)
exposure, which can cause skin breakdown and nerve
damage
- trench foot is often accompanied by infection
and increased sensitivity to pain
 Frostbite - the freezing of tissues and can be categorized as:

- first degree (superficial, “frostnip”)

- second degree (full skin),
- third degree (subcutaneous tissue)
- fourth degree (extensive tissue and bone).

- The severity of frostbite may take many days to weeks to determine

- Frostbite requires early surgical consultation once the diagnosis is made

Hypothermic Syndromes
Exercise-induced bronchospasm can be triggered by exercise in cold air,
particularly in patients with asthma.

Livedo reticularis is patchy mottling of the limbs with cold exposure.

Cryoglobulinemia occurs when immunoglobulins (IgM, IgG) reversibly

precipitate after being cooled and contribute to impaired capillary blood flow
in hypothermic tissues.

Cold urticaria is the development of localized and general erythema and wheals
in skin exposed to cold.

Paroxysmal hypothermia is periodic lowering of the thermoregulatory

set point and is often associated with hypothalamic abnormalities.

Raynaud's phenomenon is intense vasoconstriction with sensitivity to pain

in limbs exposed to cold