Dr. Shyam P Lohani

The season change is often celebrated differently in different parts of the world. It gives time to stop, recapitulate, and celebrate as a family, community, and nation which, however, mark the changes occurring around and within our immediate, national, and even international boundaries. The seasonal changes provide a gentle beat to how we experience the year with the ones we love and care about. The winter season has a rainbow of festivals and holidays throughout the world including Nepal.

While celebrating festivals and the season itself, we must play safely in order to remain healthy even in cold temperatures. Our body has to work hard so as to maintain core body temperature. This additional effort can endanger health. Therefore, it is important to carry out appropriate practices to safeguard our health. In this connection, we must be aware of a condition called hypothermia.

Risky condition
The normal core body temperature is around 98.6 degrees. When this temperature drops below 95 degrees, we call it hypothermia which is often a dangerous condition that usually is associated with prolonged exposure to cold temperatures. It is obvious that the winter months expose us to the risk of low temperature. However, a spring hike or summer sail also exposes us to the risk of hypothermia. Most of the heat loss occurs, even up to 90 per cent, through our skin and the rest from the lungs. Heat loss from the skin occurs primarily by radiation that accelerates when the skin is exposed to wind or moisture. During these cold months, immersion in cold water results in heat loss 25 times faster than it would if exposed to the same air temperature.

The temperature control centre of our body is the hypothalamus which triggers the mechanism that helps our body maintain normal body temperature even in extreme temperatures. When we are exposed to cold temperatures, our body initiates a process called shivering that produces heat through muscle activity. Another heat preserving response is vasoconstriction that narrows blood vessels.
The responsible organs of our body that produce most of body heat are the heart and liver. These organs shut down most of the activities in order to preserve heat and protect our brains in extreme cold or hot temperatures. In response to low body temperature, brain activity, breathing, and heart rate slow down. Confusion and fatigue result that hampers our ability to understand what is happening and initiate smart action to safety.

The most common symptoms of hypothermia include shivering, confusion, slow breathing, slowed speech, weakness, mumbling, stumbling, low energy, and pale skin colour. Thus, it is important to know that someone who shows excessive fatigue with a weak pulse or is unconscious may also be hypothermic. In an extremely cold temperature, our body losses heat more quickly than it can produce heat. The inability of our body to produce adequate heat is an extremely dangerous condition and warrants immediate medical attention.

Everyone is at risk of hypothermia. However, children and infants, seniors, homeless people, outdoor workers, people with mental illness and dementia, skiers, ice skaters, people living in poorly insulated homes, those living in homes without power, people with asthma are more vulnerable to cold temperatures and may succumb to hypothermic insult.
During cold temperatures, it is important to maintain adequate hydration by drinking lots of fluids. However, people often think alcohol heats us up but it is usually the opposite. Alcohol lowers our core body temperature so it is prudent to drink lots of water and some nice warm soups instead. In the cold and breathing fast, we may lose a lot of our body's water through respiration and need to recover all this lost water.
It is suggested to wear several layers of loose-fitting clothes which should be lightweight and warm rather than one layer of heavy clothing. The outer cloths should be tightly woven and it is better to have water repellent properties. Wear mittens, which are warmer than gloves. It is wise to wear a hat and cover the mouth with a scarf to protect our lungs.

Another important step to protect ourselves from cold temperature is to keep clothes dry as wet cloths may accelerate heat loss faster. Therefore, waterproof cloths help conserve heat in our body. Immediately dry up wet hair in order to protect against heat loss as the old saying “don’t go outside with your hair wet” really applies during cold winter. As our skin losses most of the heat, make sure to cover the head, ears, hands, mouth, feet, and of course chest and besides a jacket, therefore, it is an excellent idea to wear scarves, facemasks, earmuffs, vests, and gloves.

During the cold season, moving around heat up our body a bit as standing still will only make us feel colder. It is important to move slowly than fast which may exhaust our body and increase our chances of getting hypothermia. Moreover, shivering is a sign that your body temperature is beginning to fall and is an alarm that our body releases to warn us of potential danger. In such conditions, it is recommended to go inside as soon as possible to stay warm.

Take-home message
When we wear clothes that are too tight we feel colder than with clothes that are not as tight. Loose clothes trap body heat and help maintain body temperature. Besides hot soups and drinks, there are also some foods that can help warm our body in the winter such as turmeric, ginger, honey, cinnamon, sesame, dry fruits, saffron, pepper, and eggs. If you or someone you know experiences hypothermia symptoms as mentioned above, seek medical attention immediately. The take-home message is to enjoy the winter season as much as you want but keep yourselves warm with the activities that maintain your core body temperature normal.

(Prof. Lohani is the Clinical Director at Nepal Drug and Poison Information Center. lohanis@gmail.com)