Body Temperature Regulation

Body Temperature Regulation

Posted by AskNurseLinda on Mar 28, 2016 10:47 am

d14e8d1b311e561bfe001d57def8b496-huge-acTemperature regulation or controlling body temperature can be difficult with spinal cord injury due to trauma or metabolic diseases. Individuals with spinal cord injury from metabolic disease such as multiple sclerosis can have increased exacerbations due to excessive heat or cold. Pediatric aged individuals can also experience more extreme and quicker problems due to temperature variations. Adults with higher level spinal cord injury have more difficulty with temperature control due to less ability for the body to respond.

Under normal circumstances, the body will keep us comfortable between 98 and 100 degrees of temperature in an average temperature environment. No one’s body temperature is consistently 98.6 degrees. There is always some variability. An average temperature environment can vary but a comfortable range for individuals with SCI is generally between 72-74 degrees but you can enjoy higher or lower temperatures with preparation. Considerations have to be made when the body had a decrease in the ability to indicate need for warming or cooling. Besides outdoor temperature, humidity is another factor in body temperature regulation. High humidity, even in comfortable temperatures will affect your body temperature.

Body temperature is controlled by a part of the brain called the hypothalamus. The body senses warmth or coldness and sends a message to the brain to produce more or less internal heat. The hypothalamus will cause the heart to pump differently to control the amount of blood circulating. This can be pumping slightly faster or slower as well as the capillary’s opening to let the blood cool closer to the surface of the skin or tightening which keeps the blood warmer deeper inside the body.

When we become warm out first response is to move away from the heat source. This can be as simple as removing a blanket when sleeping or moving to the shade when out in the sun. Without spinal cord injury, the body will respond to warm temperatures either outside or inside the body as in fever by perspiring or sweating. Droplets of sweat evaporate to make the body feel cooler. It is sort of like running through a sprinkler as a kid. The hotter you are, the more you sweat. This will cause capillaries to respond by opening wider to fill the blood vessels so the blood can lower in temperature as it reaches our inner core.

Sweating is just one way our body tends to adjust internal temperature. There is also cooling just by breathing. Moisture is exhaled with every breath. This will cool the body. It is why dogs pant. Breathing in humans becomes quicker when too warm. Breathing in cool air can chill the body from the inside. In the winter, people will cover their nose and mouth with a scarf to keep cold air out of their lungs. The scarf will become damp or even wet with breath. However, if you use a ventilator, you want to keep fibers away from your airway.

When warm, extending arms and legs away from the trunk can increase exposure to the environment to help cool our bodies. Mist sprays can provide droplets of water to mimic sweat but not for too long. Using cooled towels and drinking iced water can help cool your body. Wear a breathable broad brimmed hat to create your own shade and use a fan if possible.

Being too cold produces a different reaction. When we are too cold, our body shivers which creates energy leading to warmth. When you become cold, blood vessels constrict allowing less blood in the capillaries, making the blood warmer as it circulates to the inner core of the body. When cold, people tend to hold their extremities close to the body to increase our own insulation to keep warm. Sometimes when we get cold, goosebumps form on our skin. This is a response which causes the hair of your body to ‘stand up’. It is a hold over response from evolution when humans were much hairier. The standing up of hair, or fur, keeps animals warmer.

To keep warm, use layers of clothing. Be sure to keep all sides of your body protected, top and bottom. Cover your extremities and your head to hold in body heat. Emergency blankets that look like silver aluminum can be obtained for a low price at drug stores. These thin blankets are used by emergency personnel but can be used by individuals to hold body heat comfortably for short periods of time.

In spinal cord injury, the senses in the skin needed to send messages through the blood of being too hot or too cold still work, but the messages cannot reach the brain for interpretation, regulation or adjustment. Typically, individuals with spinal cord injury from trauma or medical issues will not be able to adjust their body temperature below the level of the injury. They cannot sweat or shiver below the level of injury or adjust capillary flow because the brain does not receive the message that a body temperature correction needs to be made. Body heat will transfer to the environment or coldness from the environment will transfer to the body.

Body heat transfers to and from the environment through a process called conduction. If you are sitting on a cold bench, your body heat will move to warm where you are sitting. The same is true if you are sitting in a wheelchair without a blanket under you or if your body is touching the metal of the frame of the chair. Your body will transfer heat to the colder object so you will become cold but you may not notice it if you sensation is poor. The same is true if the object you are touching is too hot. Burns can easily occur. Ensuring you have covered your body on the top and underneath is a good way to protect yourself from conduction loss.

As a person moves in a cold environment, convective heat loss can also occur. If your arms and legs are positioned away from your body, there is more exposure for heat to leave your body to warm the environment. Radiant heat is exchanged just by being near something warm or cold. Being near something warm will heat your body but near something cold will cool it. Sitting on a chair over hot cement, sand, black top or in a hot car will heat your body but cold cement, sand, black top or a cold car will chill you just from the exposure of the surface.

The first symptoms of being too warm are nausea, headache, nasal congestion, tiredness, low blood pressure and reduced concentration. The skin may feel warm but only the face may flush. These are the same symptoms of Autonomic Dysreflexia (AD). Being too warm can lead to AD so catching it soon is important for both reasons. Cooling towels at the back of the neck, under arms and groin will help lower temperature. Drink cold or iced water.  Getting out of the heat is important. Find shade or air conditioning.

The consequence of being too hot is heatstroke. Symptoms of heatstroke are increased body temperature, altered mental status or behavior, flushed skin, rapid heartbeat and breathing, nausea and vomiting, and headache. Excessive sweating occurs but if you cannot sweat, you are at an even higher risk for developing heatstroke. Heatstroke is an emergency condition which requires immediate medical care to avoid damage to your brain, heart, kidneys and muscles. It can lead to death.

Symptoms of being too cold or hypothermia are increased pain, slowing of motor skills, tiredness, reduced blood pressure and heart rate. Drink warm water, cover with blankets and find a warm place.

Consequences of being too cold are frostbite and hypothermia. Frostbite is a condition where the tissue of your skin freezes. The skin may look red, or waxy. It may blister. Frostbite is painful if you have sensation. Hypothermia symptoms include shivering, slurred speech, drowsiness and loss of coordination. Avoid these conditions by limiting your exposure to the cold but should you develop these symptoms, urgent care is needed. Frostbite can lead to AD because of misinterpreted pain signals from the body.

If your extremities are exposed in a cold environment, they will become cold. If you have little or no sensation, you will not feel your extremities becoming cold but they still do. As your extremities cool, your core body will also. Compensation will not occur. Your extremities can develop frostbite as they are exposed to the cold environment. Keeping appropriate clothing including socks and gloves in addition to jackets and blankets is imperative. Areas of your face that are at risk for frostbite include your eyes due to the moisture that is exposed to the air, your lips as they contain a large number of nerve endings and your nose and ears because they have no protection as they protrude off your head.

Once your body temperature has been altered by the environment, the sympathetic nervous system will not be able to reestablish a healthy internal temperature quickly enough. This is why individuals with spinal cord injury have such a hard time getting warm. Sleep allows the nervous system to reset itself. For some, once an alteration in body temperature becomes severe, sleep is the key method for returning it to a functional level.

Your body temperature can be affected by other factors besides the environment. Medications can affect your body temperature. Anticoagulants or blood thinners, sedatives, pain medication such as opiods and some antispasmotics such as baclofen and valium can lead to feeling cold. Alcohol leads to increasing body coldness due to fluid shifts, impaired judgment and awareness. Hormones in both males and females can make you feel too cold or too warm.

Keeping the temperature of the environment in a comfort range can be obtained inside your home or buildings but going from place to place or enjoying the out of doors can be difficult in extreme temperatures. Dressing appropriately for the weather will be essential. Air can be trapped between layers of clothing which will make staying warm much easier for your body. Transitions from home to car may need to be planned so the vehicle can be cooled or warmed prior to getting in to it. Cars and vans are mostly metal which will conduct heat or cold to your body by the process of conduction. Entering a vehicle that has already had the temperature adjusted will keep your body temperature within range.

So is it true the most heat loss in our body is from our head? Yes and no. Without spinal cord injury, the body will correct for being too hot or too cold equally throughout. However, sensation to the head is usually preserved for most people. After spinal cord injury, the body can regulate temperature above the level of injury. However, the skin over the head has little to no muscle under the skin and therefore has less insulation making temperature regulation of the head more of a challenge for everyone with or without a spinal cord injury. Therefore, when cold, wear a warm hat or when hot, use a breathable hat to keep off the intense sunrays.

dcff8f8580461852c2857fc66f7e5ff8-huge-nuI'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

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Nurse Linda

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Re: Body Temperature Regulation

Posted by midtoad on Apr 3, 2016 8:34 pm

I have found another result of getting cold. I am a C4 quadriplegic, so this may not affect all. If I get cold, my arms want to flex towards my chest. It is very difficult to keep my arm straight enough to push the joystick on my wheelchair. In practice, this makes it very difficult to get home and get indoors if I catch cold in the winter, or at any time.

 Sometimes it makes no sense that I should start to feel cold, for instance if I am sitting in a warm room, 24°C. When I get put in bed, I will be unable to sleep as I cannot relax my jaw. One thing that helps greatly to warm up in bed however, is a small electric heating pad I put on my chest, where I can feel the heat. Usually this helps me fall asleep within a few minutes, and the heating pad shuts off automatically after a while.

Re: Body Temperature Regulation

Posted by AskNurseLinda on Apr 4, 2016 9:32 am

Dear Midtoad, your post will be interesting to many readers. The body's muscles are balanced between those that push and those that pull. As you have noticed, the pulling muscles are slightly stronger so when muscles contract due to cold, they will pull in toward the body. This is exactly what you and many readers will experience. It is neat that you are so in tune with your body that you have defined this.

As a healthcare professional, I have to warn against heating pads when sensation is limited in anyway as burns can easily happen. I read that you only use the heating pad where you do have sensation. Just be very careful. Your body will rewarm itself as you increase temperature either through heat or blankets. Most often sleep will reset your internal thermostat.

Thank you for bringing up these important points. Nurse Linda

Re: Body Temperature Regulation

Posted by Joaquim_Vieira on Jun 19, 2017 8:46 pm

Good Night Nurse Linda,
First of all, I read your article about body temperature regulation an I found very enlightening. I'm a supporter, my mom live 8 years with a C4-C5 quadriplegic spinal cord. She pass the days between the chair and the bed.

According the doctors, due the age of my mom (71Y) , physiotherapy wont solve nothing, but since the person who takes care start doing physiotherapy exercises, she start to feel more in the arms and the belly. Retourning to the main subject, all summers I have the same problem with the heat. It's make me suffer see my mom suffering too because the heat. We are from Portugal, and we live inside country, in a village not to big  and the heat there in this case took to 45 degree celsius or 113ºF this week.
Our house its constructed in stone, so in the day heat and the night the heat pass throught the sleeping room,

In the night I try like you say on th article put a warm to cold towel on her the head, not to much soaked and passing to hands and feet.

I try so hard search one air conditioning medical support, but i'm afraid since my mom it's very sensible and she has a catheter 24h/24h, because the person who take care have afraid to hurt my mom and she can't do it alone. I work in Germany and i'm not there to do it and for this reason she have constant urinal infections so her defence system it's always fragile. I would like to know to what extent it is beneficial to buy an air conditioning system to install in the room. My mom always have clothes. We have a fan/blower in the room pointing to the ceiling to make the air cold. but dont work. My mom drink a lot warm water. I already told her to start drinking more fresh water.

Hope you see this response and have some ideia better than mine.
Sorry for any error in my english.

Thanks for listening

Joaquim Vieira
Thanks for the Knowledge BR Joaquim Vieira

Re: Body Temperature Regulation

Posted by AskNurseLinda on Jun 20, 2017 9:03 am

Dear Joaquim, thank you for your email. Your concern for your mother is a testament to what a wonderful person she must be.
It is very difficult to control the temperature in areas where air conditioning is not standard. Using a fan to circulate the air around her but not on here is an excellent idea. A cool cloth is helpful especially on the forehead where she can feel the comfort as well as on her body where she may not feel it but it will help reduce her body temperature. She should retain a normal body temperature, not lower it below that. Since she has a urinary catheter, she should drink cool fluids. If she has a heart condition, she would not be able to tolerate a lot of fluid but if her heart is stable. Start slowly, increasing her fluid just a half a cup a day or even less if she is not able to tolerate the increase. Increasing fluids must be done slowly to allow the body time to accommodate for the volume. You might notice an increase in edema in the legs and hands but this can be controlled by having her caretaker do movement with her body. This will help edema and urinary tract infections.
Slow and cautious is the key to increasing fluids. Be sure to check with here healthcare professional to make sure there is nothing in her medical status that would prevent this increase.
Best wishes on the quest of care for your mother. Nurse Linda

Re: Body Temperature Regulation

Posted by SpearJanis on Jul 14, 2017 1:17 pm

My husband is a C5 incomplete Quad and battles with cold when he sleeps.  I pile several blankets, sheets, and towels on him all over his body, but his legs still feel cold all the time.  I believe in his case it is how his neuropathic pain is manifesting, but to make it a bit more difficult, sometimes he needs the blankets removed from his top half during the night.  

He is on the maximum dose of baclofen, and I read in your article that this can affect it as well.  

Getting the temperature just right is a real daily effort, but it is useful to know that the body resets after sleep - this has put me a bit at ease so I can try again tomorrow with not much or no harm done. I will learn to relax a bit in time, but he has only been home from rehab for 3 days today, so we are still learning.

Re: Body Temperature Regulation

Posted by AskNurseLinda on Jul 14, 2017 6:39 pm

Dear Janis, at three days home, you both must be doing a wonderful job! Body temperature regulation is a tough situation. Putting it together with neuropathic pain is deep thinking.
Be sure to check the temperature of the environment. It is so hot across the country that air conditioners are running at full speed. Sometimes, the air in the environment can be too chilled for someone with spinal cord injury or even sitting or sleeping in a cold air current. Turning down the thermostat a few degrees will help you see if you can affect your husband's internal thermostat.
Also, since you are just home three days, your husband might still be wearing TED hose. The purpose of these, as you know, is to help keep edema from collecting in the legs and assist with blood flow while protecting from deep venous blood clots. I am wondering if they are too tight or wrinkled which can impede blood flow to a point where the circulation is diminished. Circulating blood keeps us warm. If he has a lot of edema during the day or if his legs are lacking circulation as noticed by either being pale or ashy, you will want to elevate his legs in the daytime. If you have a home health nurse or if you know how to check pedal pulses, you will want someone to assess the circulation in that way.
Best wishes as you go. You certainly have a good handle on things. Nurse Linda

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