Hemofiltration in very severe hypothermia with favorable outcome

Hypothermia is a dangerous situation. It is defined by a core temperature of less than 35 degrees C. Aggressive rewarming is used if it is lower than 30 degrees C, comprising extracorporeal therapies. A case of a 63 year old lady is reported whose temperature was 21.8 degrees C, circulation was unstable, respiratory insufficiency prevailed and severe neurological dysfunction. Serum potassium was 2.9 mmol/l and pH corrected for temperature 7.61. The patient was rewarmed by hemofiltration (HF) over 6 hours with substitution of 18 l of a solution containing a concentration of potassium of 5 mmol/l. Though potassium levels declined initially and than slowly normalized in 9 hours there were no arrhythmias documented. The ECG showed prolongation of the PQ-, QRS-, and especially the QT-times. All clinical and neurological sequelae had disappeared after four days. HF thus seems to be a safe method of rewarming in very severe hypothermia.