Hypothermia fatalities in a temperate climate: Sydney, Australia

Fatal hypothermia is well known to occur in cold climates, with previous case series reflecting this. However, hypothermia can also occur in temperate climates. This case series describes the features and circumstances surrounding hypothermia-related deaths in Sydney, Australia.

The files of hypothermia-related deaths were reviewed at the Department of Forensic Medicine, Glebe between 1 January 2001 and 31 December 2005 via a search of electronic autopsy records.

Twenty-four cases of fatal hypothermia were found. Many of the deaths occurred in winter (46%). The mean age was 76 years (range 56-92), with a female predominance (63%). Risk factors for hypothermia were identified in 58%. The mean body mass index (BMI) was 22 (range 15-33). Nineteen cases (79%) were found indoors. Four decedents were found naked, four were dressed in minimal amounts of clothing, and paradoxical undressing was found in seven cases. Pathological findings included gastric erosions (79%), and patchy reddish brown discoloration over large joints (75%). The majority of cases had significant pre-existing natural disease processes. Out of 18 cases where toxicology was performed, alcohol was detected in four cases, while other psychotropic agents were present in four deaths. No illicit drugs were detected.

This study shows that fatal hypothermia, a significant public health problem, is not limited to cold climates. Forensic pathologists in Australia need to be aware of this condition, and not dismiss death as due to natural disease processes.