Prepared by Aktif International Hospital Editorial Board .

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What is hypothermia? Why does body temperature drop? When does hypothermia become dangerous?

A drop in body temperature, which can also lead to hypothermia, may occur due to causes such as wearing inadequate clothing in cold weather, remaining in wet or damp clothes for a long time, being exposed to wind, coming into contact with cold water, or staying in indoor environments that are not adequately heated.

Hypothermia, in its simplest definition, is a condition in which the body loses heat faster than it can produce it, causing the core body temperature to fall to a level that disrupts normal bodily functions. Although every low body temperature measurement does not necessarily indicate hypothermia, a body temperature below 35°C accompanied by confusion, impaired speech, or loss of balance is considered a medical emergency.

Shivering is an important warning sign at the beginning of hypothermia. However, after a certain point, the cessation of shivering may indicate that the condition is becoming more serious rather than improving, contrary to what is commonly assumed. This can be one of the critical warning signs of hypothermia. In such cases, if you notice profound drowsiness or confusion in addition to a low temperature reading, you should call emergency services immediately.

In the rest of our article, we will explain the symptoms of hypothermia, the correct first-aid steps that can save lives, and what you need to know about the hospital treatment process.

Who is at greater risk of hypothermia?

When people think of hypothermia, snowy mountains or freezing winter days usually come to mind. However, the danger is not always limited to what the outdoor thermometer shows. The body’s ability to produce heat, a person’s level of physical activity, the medications they use, and their living conditions can completely change the situation. Therefore, while one of two people in the same environment may rapidly develop hypothermia, the other may remain unaffected. So, who is at risk of hypothermia and who is more vulnerable?

Babies and young children: Compared with adults, they have greater difficulty maintaining a stable body temperature. In addition, symptoms of hypothermia in babies do not always include obvious shivering. Cold skin, becoming unusually quiet, or loss of energy are among the most important warning signs.
Older adults: As people age, the body’s response to temperature changes becomes weaker, and mobility may decrease.
People with chronic illnesses: Reduced thyroid function, low blood sugar, severe infections, or malnutrition can impair the body’s ability to produce heat.

Not only outdoor temperatures but also indoor conditions can be just as dangerous as exposure outside. Below, let us take a closer look at other situations that may lead to hypothermia.

What conditions can cause hypothermia other than cold weather?

The air temperature does not necessarily have to be below freezing for hypothermia to develop. Staying for a long time in cool, rainy, and windy weather, remaining in wet clothing, or falling into cold water may cause the body to lose heat faster than it can produce it.

Other important risk factors that may be overlooked in everyday life include:

Effects of cold water and wind: Water causes the body to lose heat much faster than air. Even when the weather is not extremely cold, falling into cold water or remaining in wet clothes while exposed to wind can trigger a dangerous drop in body temperature.
Indoor hypothermia: Even when there is no snow, older adults or people with limited mobility who live in inadequately heated homes may be at serious risk of indoor hypothermia. Health authorities also emphasize that exposure to cold indoor environments should not be overlooked, particularly among vulnerable groups.
Extreme fatigue and inadequate nutrition: Depleted energy reserves reduce the body’s ability to generate heat.

What are the symptoms of hypothermia?

Symptoms of hypothermia vary depending on how far the body temperature has fallen and how long the person has been exposed to cold. As the condition progresses, the person not only feels cold but also begins to lose the ability to think clearly, move normally, and recognize dangers in the surrounding environment. For this reason, even the smallest change in the behaviour of someone exposed to cold can be very important.

Common symptoms of hypothermia include:

Uncontrollable shivering
Weakness and profound fatigue
Reduced manual dexterity and difficulty with fine motor movements
Loss of balance
Slowed thinking and confusion
Reduced awareness of the surroundings and memory problems
Difficulty finding words or slurred speech
Marked drowsiness
In advanced stages, slowed breathing and pulse, followed by loss of consciousness

Hypothermia directly affects the brain, making it difficult for a person to think clearly and take the necessary steps to protect themselves. Another particularly important issue is the cessation of shivering.

As the condition progresses, reduced or completely absent shivering is not a sign of recovery. On the contrary, it is a more serious finding indicating that the body’s heat-producing mechanisms are becoming exhausted. A person who has remained in the cold for a long time, is no longer shivering, and has become confused may have reached a highly dangerous stage.

The situation may be somewhat different in babies. Babies do not always respond by shivering in the same way adults do. Cold skin and a noticeable loss of energy are among the most important warning signs in infants.

So, how does the clinical picture change as body temperature decreases through the different stages of hypothermia?

How do symptoms change in mild, moderate, and severe hypothermia?

As the severity of hypothermia increases, the body’s responses also change. Because obtaining an accurate temperature measurement with a thermometer is not always possible, clinical observation and the person’s level of consciousness are critically important:

Mild hypothermia: Generally associated with a body temperature of 35–32°C. The person remains conscious and usually shivers intensely. Fatigue, loss of coordination, and reduced manual dexterity begin to develop. The person can still speak but may have difficulty performing fine movements.
Moderate hypothermia: Approximately 32–28°C. Confusion, profound weakness, and increasing drowsiness become more pronounced. One of the most critical details at this stage is that shivering may stop.
Severe hypothermia: At this advanced stage, usually around 28–24°C or lower, the person may lose consciousness. Breathing and pulse may slow to dangerous levels, and in severe cases, vital signs may become difficult to detect.

Considering these symptoms, a person who was shivering but gradually becomes quiet, increasingly sleepy, or stops shivering altogether should never be ignored. If changes in consciousness, speech, or coordination are noticed, professional medical assistance should be sought immediately.

How is first aid performed for hypothermia?

The main goals of first aid for hypothermia are to prevent further heat loss, keep the person warm in a controlled manner, and obtain emergency medical assistance before the condition worsens. Interventions at the scene are extremely important. Correct actions taken before medical assistance arrives can play a vital role in preventing the condition from becoming more severe.

The basic first-aid steps that should be followed include:

Change the environment: Immediately move the person away from a windy, wet, or cold environment and take them to a dry, sheltered, and enclosed place.
Replace wet clothing: Gently remove wet clothes and wrap the person in dry clothing, towels, or blankets to prevent further heat loss.
Warm the core of the body: When warming the person, focus on central areas such as the chest, neck, and torso rather than the hands or feet. The aim is not to expose the person to sudden, extreme heat but to allow gradual and controlled warming.
Monitor consciousness and breathing: Closely monitor increasing drowsiness, changes in speech, and the person’s responses to their surroundings.
Provide fluids when appropriate: If the person is fully conscious, a warm drink may be given. However, nothing should be given by mouth to a person whose consciousness is impaired or who is unconscious.

So far, we have discussed what should be done during this critical process. There are also actions that should be avoided. In the next section, let us look at what should not be done while providing first aid to a person with hypothermia.

What should not be done in hypothermia?

Some well-intentioned but incorrect interventions during hypothermia can make the situation worse. The most common mistakes and actions that should be avoided include:

Giving alcohol: Although alcohol may create a temporary sensation of warmth, it dilates blood vessels and accelerates heat loss. It should never be considered part of the treatment.
Giving food or fluids to an unconscious person: Because the swallowing reflex may be impaired, this can cause food or liquid to enter the airway.
Applying excessive and uncontrolled heat: Suddenly placing the person in an extremely hot environment or applying very hot objects directly to the body may put the heart rhythm at risk.

If the person is not responding normally or their breathing has weakened, do not wait at home to see whether they improve with your own measures. In such situations, correct first aid means stopping further heat loss, avoiding harmful interventions, and contacting professional emergency services without delay.

When should I call 112 for hypothermia?

In hypothermia, you should never wait until the person completely loses consciousness before seeking emergency help. Even a minor deterioration in consciousness, speech, or movement can indicate that the condition is serious. Calling 112 at an early stage can save a life and prevent the condition from progressing.

You should call 112 without delay if any of the following occurs:

Changes in consciousness and awareness: The person is confused, does not respond appropriately, has difficulty understanding where they are, or is so deeply drowsy that they cannot be awakened.
Speech and movement problems: Their speech has become slurred, or their ability to walk or maintain balance has noticeably deteriorated.
Breathing and pulse problems: Their breathing or pulse has become very slow, they are not responding normally, or they are not breathing.
Severe exposure and low body temperature: The person has experienced significant cold exposure, such as falling into cold water, or a reliable measurement shows that their body temperature is below 35°C.

Warnings and recommendations from Aktif International Hospital emergency department doctors

Doctors in the emergency department at Aktif International Hospital emphasize that one of the most deceptive aspects of hypothermia is that the affected person may often fail to recognize how serious their condition has become. Therefore, as with many medical conditions, awareness is extremely important in hypothermia.

The key warnings and essential precautions highlighted by our emergency medicine specialists include:

Don’t make the mistake of thinking, “I’m fine”: Closely observe their speech, balance, level of consciousness, and responses to the environment. If confusion, slurred speech, loss of coordination, or reduced shivering occurs, you should call 112 immediately rather than waiting at home.
Never move the person roughly: Do not unnecessarily make someone with suspected moderate or severe hypothermia walk or move them using sudden, forceful movements. Because the heart rhythm can become extremely sensitive at this stage, handling the patient as gently and carefully as possible is vital.
Do not rely solely on surface temperature measurements: Keep in mind that forehead or ear thermometers used at home may not always accurately reflect the true core body temperature.
Recognize warning signs carefully in high-risk groups: Symptoms may be much less obvious in children, older adults, and people with chronic illnesses. Rather than waiting for severe shivering, focus on early signs such as behavioural changes, weakness, or unusual drowsiness.
Replace wet clothing immediately: Do not assume that someone is safe simply because they appear well after coming out of cold water or after prolonged exposure to wind and moisture. Remove wet clothing immediately, keep the person warm in a dry and sheltered environment, and regularly monitor their level of consciousness.

How is hypothermia diagnosed? How is hypothermia treated?

The diagnosis of hypothermia is never based solely on the number shown on a thermometer. In healthcare settings, the duration of cold exposure, level of consciousness, presence or absence of shivering, and whether there is another underlying health problem are carefully evaluated.

The treatment process is determined entirely by the severity of hypothermia. Warming every patient in the same way is not appropriate. Passive methods may be sufficient in mild cases, whereas moderate and severe cases require active rewarming and close monitoring in a hospital setting.

When diagnosing hypothermia in a hospital, healthcare professionals assess not only how far the body temperature has dropped but also what caused the condition:

Cardiac rhythm and laboratory assessment: Heart rhythm is checked with an electrocardiogram (ECG). Blood glucose, blood gases, electrolytes, and kidney function are also assessed.
Identifying underlying causes: If body temperature has fallen without obvious cold exposure, conditions such as hypoglycaemia, severe infections, thyroid disorders, adrenal insufficiency, or medication effects are carefully investigated.

Hypothermia treatment primarily aims to stop further heat loss and increase body temperature in a controlled manner. Current clinical guidelines generally divide rewarming methods into three main categories:

Passive external rewarming (Mild cases): If the person is conscious, circulation is stable, and they are still shivering, removing wet clothing, moving them to a dry environment, and wrapping them in blankets may be sufficient. The body can then begin producing its own heat and recover gradually.
Active external rewarming (Moderate cases): In a hospital setting, special forced-air warming blankets or controlled warming systems applied to the torso may be used. At this stage, it is vital that the patient is moved very carefully and that sudden or rough movements are avoided.
Active internal rewarming and advanced support (Severe cases): When external warming alone is insufficient, warmed intravenous fluids may be used. These approaches are particularly considered for high-risk patients whose body temperature is below 30°C or who have low blood pressure or heart rhythm abnormalities.

Accurate clinical assessment and controlled treatment steps tailored to the individual play an important role in successfully managing these critical situations.

How can hypothermia be prevented?

Even when it is not a freezing winter day, factors such as rain, wind, sweating, or cold water can cause the body to lose heat rapidly. For this reason, prevention should not be based solely on the question of “How cold is it outside?” but should also take the current environmental conditions into account.

The basic measures that can help prevent hypothermia include:

Dress appropriately in layers: Instead of wearing one very thick garment, choose several layers of clothing that trap air between them. Protecting the ears, face, hands, and feet and wearing waterproof, insulated footwear can significantly reduce heat loss.
Make an effort to stay dry: Getting wet causes body temperature to fall much faster than normal. If your clothes become wet due to rain, snow, or sweat, you should change them. If you will be spending a long time outdoors, always carry spare socks, gloves, a hat, and dry clothing.
Avoid excessive sweating: Wearing too many layers and performing intense physical activity in cold weather may first cause sweating and then lead to much faster cooling because of the moisture. Adjust your clothing layers according to your activity level.
Limit exposure time and consider the conditions: Plan the amount of time you spend outdoors according to wind and precipitation. In very cold conditions, keep outdoor exposure brief and take regular breaks in warm environments.
Take precautions during cold-water activities: Water removes body heat much faster than air. During activities such as swimming, always use protective clothing appropriate for the conditions.

If body temperature has fallen and symptoms of hypothermia develop despite all these precautions, time should not be lost relying solely on measures that can be taken at home. The situation should be treated immediately as a medical emergency.