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Chapter 13 - Hypothermia and Hyperthermia in Elders

Published online by Cambridge University Press:  11 July 2020

Kim A. Collins
LifePoint Inc, South Carolina
Roger W. Byard
University of Adelaide
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This can be for a combination of physiological, pathological, social, and environmental reasons. In the geriatric population, homeostasis becomes more difficult to maintain and elders are more challenged by changes in the environment. They are vulnerable because of changes in thermoregulation, underlying medical conditions such as dementia and cardiovascular

Publisher: Cambridge University Press
Print publication year: 2020

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Kuchel, GA. Aging and homeostatic regulation. In Halter, JB, Ouslander, JG, Studenski, S, et al., eds. Hazzard’s Geriatric Medicine and Gerontology, 7th edn. New York: McGraw-Hill Education; 2017: pp. 681–90.Google Scholar
Milroy, CM, Parai, JL. Deaths from extremes of temperature. In Rutty, GN, ed. Essentials of Autopsy Practice. Berlin: Springer; 2012: pp. 3752.Google Scholar
Hall, JE (ed.) Body temperature, temperature regulation and fever. In Guyton and Hall Textbook of Medical Physiology, 13th edn. Philadelphia, PA: Elsevier; 2016: pp. 911–22.Google Scholar
Morrison, SF, Nakamura, K, Madden, CJ. Central control of thermogenesis in mammals. Exp Physiol. 2008; 93: 773–97.CrossRefGoogle ScholarPubMed
Rode, A, Shephard, RJ. Basal metabolic rate of Inuit. Am J Hum Biol. 1995; 7: 723–9.CrossRefGoogle ScholarPubMed
Beckman, EL, Reeves, E, Goldman, RF. Current concepts and practices applicable to the control of body heat loss in aircrew subjected to water immersion. Aerospace Med. 1963; 37: 348–57.Google Scholar
Leonard, WR, Sorensen, MV, Galloway, VA et al. Climatic influences on basal metabolic rates among circumpolar populations. Am J Human Biol. 2002; 14: 609–20.CrossRefGoogle ScholarPubMed
Castellani, JW, Young, AJ. Human physiological responses to cold exposure: acute responses and acclimatization to prolonged exposure. Auton Neurosci. 2016; 30(196): 6374.CrossRefGoogle Scholar
Daanen, HAM, Racinais, S, Périard, JD. Heat acclimation decay and re-induction: a systematic review and meta-analysis. Sports Med. 2018; 48: 409–30.CrossRefGoogle ScholarPubMed
Horowitz, M. Lessons from gold mines. Temperature. 2017; 4: 107–8.CrossRefGoogle ScholarPubMed
Schneider, SM. Heat acclimation: gold mines and genes. Temperature. 2016; 4: 527–38.Google Scholar
Fulop, T, Larbi, A, Witkowski, JM, et al. Aging, frailty and age-related diseases. Biogerontology. 2010; 11: 547–63.CrossRefGoogle ScholarPubMed
Troncale, JA. The aging process: physiologic changes and pharmacologic implications. Postgrad Med. 1996; 99: 111–22.CrossRefGoogle ScholarPubMed
Xue, QL. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011; 27: 15.CrossRefGoogle ScholarPubMed
Guly, H. History of accidental hypothermia. Resuscitation. 2011; 82: 122–5.CrossRefGoogle ScholarPubMed
Gilbert, M, Busund, R, Skagseth, A et al. Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. Lancet. 2000; 355: 375.CrossRefGoogle ScholarPubMed
Epstein, E, Anna, K. Accidental hypothermia. BMJ. 2006; 332: 706–9.CrossRefGoogle ScholarPubMed
Sivaloganathan, S. Paradoxical undressing and hypothermia. Med Sci Law. 1986; 26: 225–9.CrossRefGoogle ScholarPubMed
Shetty, MR. Cause of death among passengers on the Titanic. Lancet. 2003; 361(9355): 438.CrossRefGoogle ScholarPubMed
Angell, M. The Nazi hypothermia experiments and unethical research today. N Eng J Med. 1990; 322: 1462–4.CrossRefGoogle ScholarPubMed
Berger, RL. Nazi science: the Dachau hypothermia experiments. N Eng J Med. 1990; 322: 1435–40.CrossRefGoogle ScholarPubMed
Keatinge, WR. Death after shipwreck. BMJ. 1965; 25: 1537–41.Google Scholar
Rees, JR. Accidental hypothermia. Lancet. 1958; 1(7020): 556–9.Google ScholarPubMed
Emslie-Smith, D. Accidental hypothermia: a common condition with a pathognomonic electrocardiogram. Lancet. 1958; 272(7045): 492–5.Google Scholar
Duguid, H, Simpson, RG, Stowers, JM. Accidental hypothermia. Lancet. 1961; 2(7214): 1213–9.Google ScholarPubMed
Read, AE, Gough, KR, Emslie-Smith, D et al. Pancreatitis and accidental hypothermia. Lancet. 1961; 278(7214): 1219–21.CrossRefGoogle Scholar
Prescott, LF, Peard, MC, Wallace, IR. Accidental hypothermia. BMJ. 1962; 2(5316): 1367–70.CrossRefGoogle ScholarPubMed
McNicol, MW, Smith, R. Accidental hypothermia. BMJ. 1964; 1(5374): 1921.CrossRefGoogle ScholarPubMed
Mant, AK. Some post-mortem observations in accidental hypothermia. Med Sci Law. 1964; 4: 44–6.CrossRefGoogle ScholarPubMed
Famma, PG, Paton, WB, Bostock, MI. Accidental hypothermia in the elderly. BMJ. 1964; 2(5419): 1255–8.Google ScholarPubMed
Exton-Smith, AN. Medicine in old age. Accidental hypothermia. BMJ. 1973; 4(5894): 727.CrossRefGoogle ScholarPubMed
Royal College of Physicians of London. Report of Committee on Accidental Hypothermia. London: Royal College of Physicians; 1966.Google Scholar
Fox, RH, Woodward, PM, Exton-Smith, AN et al. Body temperatures in the elderly: a national study of physiological, social, and environmental conditions. BMJ. 1973;1(5847): 200–6.CrossRefGoogle ScholarPubMed
Collins, KJ, Dore, C, Exton-Smith, AN et al. Accidental hypothermia and impaired temperature homoeostasis in the elderly. BMJ. 1977; 1(6057): 353–6.CrossRefGoogle ScholarPubMed
Collins, KJ. Low indoor temperatures and morbidity in the elderly. Age Ageing. 1986; 15(4): 212–20.CrossRefGoogle ScholarPubMed
Rango, N. Exposure-related hypothermia mortality in the United States, 1970–79. Am J Pub Health. 1984; 74: 1159–60.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Hypothermia-related deaths: United States, 2003–2004. MMWR Morb Mortal Wkly Rep. 2005; 54: 173–5.Google Scholar
Meiman, J, Anderson, H, Tomasallo, C. Hypothermia-related deaths: Wisconsin, 2014, and United States, 2003–2013. MMWR: Morb Mortal Wkly Rep. 2015; 64: 141.Google ScholarPubMed
Noe, RS, Jin, JO, Wolkin, AF. Exposure to natural cold and heat: hypothermia and hyperthermia Medicare claims, United States, 2004–2005. Am J Pub Health. 2012; 102: e11–8.CrossRefGoogle ScholarPubMed
Pedley, DK, Paterson, B, Morrison, W. Hypothermia in elderly patients presenting to accident & emergency during the onset of winter. Scott Med J 2002; 47: 1011.CrossRefGoogle ScholarPubMed
Brändström, H, Eriksson, A, Giesbrecht, G et al. Fatal hypothermia: an analysis from a sub-arctic region. Int J Circumpolar Health. 2012; 71 :17.CrossRefGoogle ScholarPubMed
Lim, C, Duflou, J. Hypothermia fatalities in a temperate climate: Sydney, Australia. Pathology. 2008; 40: 4651.CrossRefGoogle Scholar
Kibayashi, K, Shojo, H. Accidental fatal hypothermia in elderly people with Alzheimer’s disease. Med Sci Law. 2003; 43: 127–31.CrossRefGoogle ScholarPubMed
Furumiya, J, Hashimoto, Y. A descriptive study of elderly patients with dementia who died wandering outdoors in Kochi Prefecture, Japan. Am J Alzheimers Dis Other Demen. 2015; 30: 307–12.CrossRefGoogle ScholarPubMed
Weyman, AE, Greenbaum, DM, Grace, WJ. Accidental hypothermia in an alcoholic population. Am J Med. 1974; 56: 1321.CrossRefGoogle Scholar
Taylor, AJ, McGwin, G, Davis, GG et al. Hypothermia deaths in Jefferson County, Alabama. Inj Prev. 2001; 7: 141–5.CrossRefGoogle ScholarPubMed
Stares, J, Kosatsky, T. Hypothermia as a cause of death in British Columbia, 1998−2012: a descriptive assessment. CMAJ Open. 2015; 3: E352–8.CrossRefGoogle ScholarPubMed
Danzl, DF. Accidental hypothermia. In Auerbach, PS, ed. Wilderness Medicine. 5th edn. Philadelphia, PA: Mosby Elsevier; 2007: pp. 125–60.Google Scholar
Danzl, DF, Pozos, RS. Accidental hypothermia. N Eng J Med. 1994; 331: 1756–60.CrossRefGoogle ScholarPubMed
Marcus, EL, Rudensky, B, Sonnenblick, M. Occult elevation of CK as a manifestation of rhabdomyolysis in the elderly. J Am Geriatr Soc. 1992; 40: 454–6.CrossRefGoogle ScholarPubMed
Morgan, M, Schwartz, L, Duflou, J. Hypothermia secondary to glioblastoma multiforme? Autopsy findings in two cases. J Forensic Sci. 2015; 60: 511–3.CrossRefGoogle ScholarPubMed
Byard, RW, Bright, FM. Lethal hypothermia – a sometimes elusive diagnosis. Forensic Sci Med Pathol 2018; 14(4): 421–3.CrossRefGoogle ScholarPubMed
Epstein, E, Anna, K. Accidental hypothermia. BMJ. 2006; 332: 706–9.CrossRefGoogle ScholarPubMed
Anderson, TW, Le Riche, WH. Cold weather and myocardial infarction. Lancet. 1970; i: 291–6.Google Scholar
Wilmhurst, P. Temperature and cardiovascular mortality. BMJ. 1994; 309: 1029–30.Google Scholar
Jeremitsky, E, Omert, L, Dunham, C et al. Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion. J Trauma. 2003; 54: 312–19.CrossRefGoogle ScholarPubMed
Clifton, GL, Miller, ER, Sung, CC et al. Lack of effect of induction of hypothermia after acute brain injury. New Eng J Med. 2001; 344: 556–63.CrossRefGoogle ScholarPubMed
Shafi, S, Elliott, AC, Gentilello, L. Is hypothermia simply a marker of shock and injury severity or an independent risk factor for mortality in trauma patients? Analysis of a large national trauma registry. J Trauma. 2005; 59: 1081–85.Google ScholarPubMed
Young, DM. Risk factors for hypothermia in psychiatric patients. Ann Clin Psychiatry. 1996; 8: 93–7.CrossRefGoogle ScholarPubMed
Schwaninger, M, Weisbrod, M, Schwab, S et al. Hypothermia induced by atypical neuroleptics. Clin Neuropharmacol. 1998; 21: 344–6.Google ScholarPubMed
Blass, DM, Chuen, M. Olanzapine-associated hypothermia. Psychosomatics. 2004; 45(2): 135–9.CrossRefGoogle ScholarPubMed
Scherl, TA, Langguth, B, Kreuzer, PM. Hypothermia associated with antipsychotic medication: a clinical surveillance study. J Clin Psychopharmacol. 2017; 37: 751–3.CrossRefGoogle ScholarPubMed
Mallet, ML. Pathophysiology of accidental hypothermia. QJM. 2002; 95: 775–85.CrossRefGoogle ScholarPubMed
Osamu, S, Keiko, S, Hiroshi, S et al. Diagnosis of fatal hypothermia: incidence of specific medico-legal findings in fatal hypothermia cases. Acta Criminol Med Leg Jpn. 2002; 68: 5660.Google Scholar
Rothschild, MA, Schneider, V. “Terminal burrowing behaviour”: a phenomenon of lethal hypothermia. Int J Leg Med. 1995; 107: 250–6.CrossRefGoogle ScholarPubMed
Carter, N, Green, MA, Milroy, CM et al. Terminal burrowing behaviour: a phenomenon of lethal hypothermia. Int J Leg Med. 1995; 108: 116.CrossRefGoogle ScholarPubMed
Hirvonen, J. Necropsy findings in fatal hypothermia cases. Forensic Sci. 1976; 8: 155–64.CrossRefGoogle ScholarPubMed
Türk, EE, Sperhake, JP, Madea, B et al. Immunohistochemical detection of hemoglobin in frost erythema. Forensic Sci Int. 2006; 158: 131–4.CrossRefGoogle ScholarPubMed
Tsokos, M, Rothschild, M, Madea, B et al. Histological and immunohistochemical study of Wischnevsky spots in fatal hypothermia. Am J Forensic Med Pathol. 2006; 27: 70–4.CrossRefGoogle ScholarPubMed
Hejna, P, Zátopková, L, Tsokos, M. The diagnostic value of synovial membrane hemorrhage and bloody discoloration of synovial fluid (“inner knee sign”) in autopsy cases of fatal hypothermia. Int J Leg Med. 2012; 126: 415–9.CrossRefGoogle ScholarPubMed
Birchmeyer, MS, Mitchell, EK. Wischnewski revisited. The diagnostic value of gastric mucosal ulcers in hypothermic deaths. Am J Forensic Med. 1989; 10: 2830.CrossRefGoogle ScholarPubMed
Byard, RW, Zhou, C. Erosive gastritis, Armanni-Ebstein phenomenon and diabetic ketoacidosis. Forensic Sci Med Pathol. 2010; 6: 304–6.CrossRefGoogle ScholarPubMed
Bright, F, Winskog, C, Byard, RW. Wischnewski spots and hypothermia: sensitive, specific, or serendipitous? Forensic Sci Med Pathol. 2013; 9: 8890.CrossRefGoogle ScholarPubMed
Ogata, M, Ago, K, Ago, M et al. A fatal case of hypothermia associated with hemorrhages of the pectoralis minor, intercostal, and iliopsoas muscles. Am J Forensic Med Pathol. 2007; 28: 348–52.CrossRefGoogle ScholarPubMed
Aghayev, E, Thali, MJ, Jackowski, C et al. MRI detects hemorrhages in the muscles of the back in hypothermia. Forensic Sci Int. 2008; 176: 183–6.CrossRefGoogle Scholar
Preuss, J, Dettmeyer, R, Lignitz, E, Madea, B. Fatty degeneration of myocardial cells as a sign of death due to hypothermia versus degenerative deposition of lipofuscin. Forensic Sci Int. 2006; 159: 15.CrossRefGoogle ScholarPubMed
Preuss, J, Lignitz, E, Dettmeyer, R, Madea, B. Pancreatic changes in cases of death due to hypothermia. Forensic Sci Int. 2007; 166: 194–8.CrossRefGoogle ScholarPubMed
Preuss, J, Dettmeyer, R, Lignitz, E et al. Fatty degeneration in renal tubule epithelium in accidental hypothermia victims. Forensic Sci Int. 2004; 141: 131–5.CrossRefGoogle ScholarPubMed
Zhou, C, Byard, RW. Armanni-Ebstein phenomenon and hypothermia. Forensic Sci Int. 2011; 206: e82–4.CrossRefGoogle ScholarPubMed
Milroy, C, Parai, JL. The Armanni-Ebstein lesion and the post-mortem diagnosis of ketoacidosis. Acad Forensic Pathol. 2012; 2: 158–64.CrossRefGoogle Scholar
Parai, JL, Kodikara, S, Milroy, CM, et al. Alcoholism and the Armanni-Ebstein lesion. Forensic Med Pathol. 2012; 8: 1922.CrossRefGoogle ScholarPubMed
Zhou, C, Byard, RW. Basal renal tubular epithelial cell vacuolization and alcoholic ketoacidosis. J Forensic Sci. 2012; 57: 126–8.CrossRefGoogle ScholarPubMed
Byard, RW, Zhou, C, Yool, AJ, Parai, JL, Milroy, CM. Armanni-Ebstein change or basal tubular vacuolization? Academ Forensic Pathol. 2012; 2: 304.CrossRefGoogle Scholar
Doberentz, E, Preuss-Wössner, J, Kuchelmeister, K, Madea, B. Histological examination of the pituitary glands in cases of fatal hypothermia. Forensic Sci Int. 2011; 207: 46–9.CrossRefGoogle ScholarPubMed
Palmiere, C, Bardy, D, Letovanec, I et al. Biochemical markers of fatal hypothermia. Forensic Sci Int. 2013; 226: 5461.CrossRefGoogle ScholarPubMed
Hirvonen, J, Huttunen, P. Increased urinary concentration of catecholamines in hypothermia deaths. J Forensic Sci. 1982; 27: 264–71.CrossRefGoogle ScholarPubMed
Sadler, DW, Pounder, DJ. Urinary catecholamines as markers of hypothermia. Forensic Sci Int. 1995; 76: 227–9.CrossRefGoogle ScholarPubMed
Teresiński, G, Buszewicz, G, Mądro, R. The influence of ethanol on the level of ketone bodies in hypothermia. Forensic Sci Int. 2002; 127: 8896.CrossRefGoogle ScholarPubMed
Coe, JI. Hypothermia: autopsy findings and vitreous glucose. J Forensic Sci. 1984; 29: 389–95.CrossRefGoogle ScholarPubMed
Turk, EE. Hypothermia. For Sci Med Pathol. 2010; 6: 106–15.Google ScholarPubMed
John, WG, Scott, KWM, Hawcroft, DM. Glycated hemoglobin and glycated protein and glucose concentrations in necropsy blood samples. J Clin Pathol. 1988; 41: 415–18.CrossRefGoogle ScholarPubMed
Tipton, M. Thermal stress and survival. In Rainford, D, Gradwell, DP, eds. Ernsting’s Aviation Medicine, 4th edn. London: Hodder Arnold; 2006: pp. 213–29.Google Scholar
Ward, M. Frostbite. BMJ. 1974: 1: 6770.CrossRefGoogle ScholarPubMed
Travis, S, Roberts, D. Arctic Willy. BMJ. 1989; 299: 1573–4.CrossRefGoogle ScholarPubMed
Koutsavlis, AT, Kosatsky, T. Environmental-temperature injury in a Canadian metropolis. J Environ Health. 2003; 66: 40–5.Google Scholar
Schäfer, AT, Kaufmann, JD. What happens in freezing bodies? Experimental study of histological tissue change caused by freezing injuries. Forensic Sci Int. 1999; 102: 149–58.Google ScholarPubMed
Bouchama, A, Knochel, JP. Heat stroke. N Engl J Med. 2002; 346: 1978–88.CrossRefGoogle ScholarPubMed
Epstein, Y, Roberts, WO. The pathophysiology of heat stroke: an integrative view of the final common pathway. Scand J Med Sci Sports. 2011; 21: 742–8.CrossRefGoogle ScholarPubMed
Hall, RC, Hall, RC, Chapman, M. Neuroleptic malignant syndrome in the elderly: diagnostic criteria, incidence, risk factors, pathophysiology, and treatment. Clin Geriatr. 2006; 14: 39.Google Scholar
Nakamura, N, Ueda, T, Ishikawa, R, et al. Malignant hyperthermia developing during esophageal resection in an 82-year-old man. J Anesth. 2008; 22: 464–6.CrossRefGoogle Scholar
Casa, DJ, Armstrong, LE, Carter, R et al. Historical perspectives on medical care for heat stroke, part 1: ancient times through the nineteenth century: a review of the literature. Athl Training Sports Health Care. 2010; 2: 132–8.Google Scholar
Casa, DJ, Armstrong, LE, Carter, R et al. Historical perspectives on medical care for heat stroke, part 2: 1850 through the present: a review of the literature. Athl Training Sports Health Care. 2010; 2: 178–90.Google Scholar
Wellsted, JR. Travels to the cities of the Caliphs along the shores of the Persian Gulf and the Mediterranean. Philadelphia: Lea and Blanchard; 1841.Google Scholar
Lee, DH. The human organism and hot environments. Trans R Soc Trop Med Hyg. 1935; 29(1): 720.Google Scholar
Wakefield, EG, Hall, WW. Heat injuries: a preparatory study for experimental heat-stroke. JAMA. 1927; 89: 92–5.Google Scholar
Hall, WW, Wakefield, EG. A study of experimental heat-stroke. JAMA. 1927; 89: 177–82.CrossRefGoogle Scholar
Ferris, EB, Blankenhorn, MA, Robinson, HW, Cullen, GE. Heat stroke: clinical and chemical observations on 44 cases. J Clin Invest. 1938; 17: 249–62.CrossRefGoogle ScholarPubMed
Haresh, M, McDonald, G, Hood, IC et al. Heat-related deaths in Philadelphia – 1993. Am J Forensic Med Pathol. 1996; 17: 106–8.Google Scholar
Kaiser, R, Rubin, CH, Henderson, AK et al. Heat-related death and mental illness during the 1999 Cincinnati heat wave. Am J Forensic Med Pathol. 2001; 22: 303–7.CrossRefGoogle ScholarPubMed
Keatinge, W. Death in heat waves. BMJ. 2003; 327: 512.CrossRefGoogle ScholarPubMed
Baccini, M, Kosatsky, T, Analitis, A et al. Impact of heat on mortality in 15 European cities: attributable deaths under different weather scenarios. J Epidemiol Community Health. 2011; 65: 6470.CrossRefGoogle ScholarPubMed
McKenzie, P, LeCount, ER. Heat stroke: with a second study of cerebral edema. JAMA. 1918; 71: 260–3.Google Scholar
Ellis, FP, Nelson, F, Pincus, L. Mortality during heat waves in New York City July, 1972 and August and September, 1973. Environ Res. 1975; 10: 13.CrossRefGoogle ScholarPubMed
Ellis, FP, Nelson, F. Mortality in the elderly in a heat wave in New York City, August 1975. Environ Res. 1978; 15: 504–12.CrossRefGoogle Scholar
Jones, TS, Liang, AP, Kilbourne, EM et al. Morbidity and mortality associated with the July 1980 heat wave in St Louis and Kansas City, Mo. JAMA. 1982; 247: 3327–31.CrossRefGoogle Scholar
Baccini, M, Kosatsky, T, Analitis, A et al. Impact of heat on mortality in 15 European cities: attributable deaths under different weather scenarios. J Epidemiol Community Health. 2011; 65: 6470.CrossRefGoogle ScholarPubMed
Whitman, S, Good, G, Donoghue, E. Mortality in Chicago attributed to the July 1995 heat wave. Am J Public Health. 1997; 87: 1515–18.CrossRefGoogle ScholarPubMed
Shen, T, Howe, HL, Alo, C et al. Toward a broader definition of heat related death: Comparison of mortality estimates from Medical examiners’ classification with those from total death differentials during the July 1995 heat wave in Chicago. Am J Forensic Med Pathol. 1998; 19: 113–18.CrossRefGoogle Scholar
Semenza, JC, Rubin, CH, Falter, KH et al. Heat-related deaths during the July 1995 heat wave in Chicago. N Engl J Med. 1996; 335: 8490.CrossRefGoogle ScholarPubMed
Dematte, JE, O’Mara, K, Buescher, J et al. Near-fatal heat stroke during the 1995 heat wave in Chicago. Ann Intern Med. 1998; 129: 173–81.CrossRefGoogle ScholarPubMed
Davido, A, Patzak, A, Dart, T et al. Risk factors for heat related death during the August 2003 heat wave in Paris, France, in patients evaluated at the emergency department of the Hôpital Européen Georges Pompidou. Emerg Med J. 2006; 23: 515–18.CrossRefGoogle ScholarPubMed
Martin-Latry, K, Goumay, M-P, Latry, P et al. Psychotropic drugs use and risk of heat-related hospitalization. Eur Psychiatry. 2007; 22: 335–8.CrossRefGoogle Scholar
Nordon, C, Martin-Latry, K, de Roquefeuil, L et al Risk of death related to psychotropic drug use in older people during the European 2003 heatwave: a population-based case-control study. Am J Geriatr Psychiatry. 2009; 17: 1059–67.CrossRefGoogle ScholarPubMed
Khogali, M. Epidemiology of heat illnesses during the Makkah Pilgrimages in Saudi Arabia. Int J Epidemiol. 1983; 12: 267–73.CrossRefGoogle ScholarPubMed
Ghaznawi, HI, Ibrahim, MA. Heat stroke and heat exhaustion in pilgrims performing the Haj (annual pilgrimage) in Saudi Arabia. Ann Saudi Med. 1987; 7: 323–6.CrossRefGoogle Scholar
Noweir, MH, Bafail, AO, Jomoah, IM. Study of heat exposure during Hajj (pilgrimage). Environ Monit Assess. 2008; 147: 279–95.CrossRefGoogle Scholar
Bouchama, A, De Vol, EB. Acid-base alterations in heatstroke. Intensive Care Med. 2001; 27: 680–5.CrossRefGoogle ScholarPubMed
Satoh, F, Osawa, M, Hasegawa, I et al. “Dead in hot bathtub” phenomenon: accidental drowning or natural disease? Am J Forensic Med Pathol 2013; 34: 164–8.CrossRefGoogle ScholarPubMed
Eren, B, Fedakar, R, Turkmen, N et al. Deaths in the Turkish hamam (hot bath). Bratisl Lek Listy. 2009; 110: 697700.Google Scholar
Suzuki, M, Shimbo, T, Ikaga, T et al. Sudden death phenomenon while bathing in Japan: mortality data. Circ J. 2017; 81: 1144–9.CrossRefGoogle ScholarPubMed
Suzuki, H, Hikiji, W, Tanifuji, T et al. Characteristics of sudden bath-related death investigated by medical examiners in Tokyo, Japan. J Epidemiol. 2015; 25: 126–32.CrossRefGoogle ScholarPubMed
Malmud, N, Haymaker, W, Custer, P. Heat stroke: a clinicopathologic study of 125 fatal cases. Milit Surg. 1946; 99: 397449.Google Scholar
Gore, I, Isaacson, NH. The pathology of hyperpyrexia: observations at autopsy in 17 cases of fever therapy. Am J Pathol. 1949; 25: 1029–105.Google ScholarPubMed
Kew, MC, Tucker, RBK, Bersohn, I et al. The heart in heatstroke. Am Heart J. 1969; 77: 324–35.CrossRefGoogle ScholarPubMed
Kew, M, Bersohn, I, Seftel, H et al. Liver damage in heatstroke. Am J Med. 1970; 49: 192202.CrossRefGoogle ScholarPubMed
Bianchi, L, Ohnacker, H, Beck, K et al. Liver damage in heatstroke and its regression: a biopsy study. Hum Pathol. 1972; 3: 237–48.CrossRefGoogle ScholarPubMed
Chao, TC, Sinniah, R, Pakiam, JE. Acute heat stroke deaths. Pathology. 1981; 13: 145–56.CrossRefGoogle ScholarPubMed
Rubel, LR, Ishak, KG. The liver in fatal exertional heatstroke. Liver. 1983; 3: 249–60.Google ScholarPubMed
Armen, R, Kanel, G, Reynolds, T. Phencyclidine-induced malignant hyperthermia causing submassive liver necrosis. Am J Med. 1984; 77: 167–72.CrossRefGoogle ScholarPubMed
Wetli, CV, Mash, D, Karch, SB. Cocaine-associated agitated delirium and the neuroleptic malignant syndrome. Am J Emerg Med. 1996; 14: 425–8.CrossRefGoogle ScholarPubMed
Milroy, CM, Clark, JC, Forrest, AR. Pathology of deaths associated with “ecstasy” and “eve” misuse. J Clin Pathol. 1996; 49: 149–53.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (CDC). Heat-related mortality – Chicago, July 1995. MMWR Morb Mortal Wkly Rep. 1995; 44: 577–9.Google Scholar
Centers for Disease Control and Prevention (CDC). Heat-wave-related mortality – Milwaukee, Wisconsin, July 1995. MMWR Morb Mortal Wkly Rep. 1996; 45: 505–7.Google Scholar
Centers for Disease Control and Prevention (CDC). Heat-related deaths – Philadelphia and United States, 1993–1994. MMWR CDC Surveill Summ. 1994; 43: 453–5.Google Scholar
Donoghue, ER, Graham, MA, Jentzen, JM et al. Criteria for the diagnosis of heat-related deaths: National Association of Medical Examiners: position paper. Am J Forensic Med Pathol. 1997; 18: 11–4.CrossRefGoogle Scholar

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