Frostbite vs. Hypothermia Differences in Symptoms and Stages

Reviewed on 2/18/2021

What Is Hypothermia? What Is Frostbite?

There are four stages of frostbite and they are similar to those of burn.

Frostbite and hypothermia are both caused by cold exposure, and each can have long-lasting effects, even death. In frostbite and hypothermia, the body tries to compensate for exposure to constant cold temperatures by maintaining constant temperatures to keep warm, which causes loss of heat production that is balanced by heat loss. Exposure to extreme elements, for example, bitter cold temperatures in the winter.

Hypothermia is defined as a body temperature less than 95 F (35 C), and signs and symptoms of mild hypothermia are lethargy and confusion. As the body temperature continues to decrease, the person becomes more confused, which results in poor decision-making. Instead of coming out of the cold, apathy sets in, and the person may become delirious and eventually take off their clothes, curl up in a ball, and then dies of sudden cardiac death.

When the body is exposed to extreme elements, for example, bitter cold temperatures in the winter, it tries to protect the internal organs by taking blood away from the skin and moves it to the internal organs to generate heat, which sacrifices expendable parts like fingers and toes that can cause frostbite. Hypothermia is caused by shivering, which causes the body to generate heat, and then it compensates for the temporary (short-lived)) exposure to the cold. However, if the body remains in the cold, bad things can happen very quickly because the electrical conducting systems of the brain and heart are very sensitive to decreasing core body temperatures, and as a result, they begin to fail as body temperature decreases.

What Are the Signs and Symptoms of Frostbite? What Are the Stages?

The stages of frostbite are similar to those of burns.

  1. Frostnip or first-degree frostbite is superficial and reversible but may cause significant pain when the extremity rewarms.
  2. Second-degree frostbite is characterized by blisters that form a few hours to a day after injury and signifies deeper tissue damage.
  3. Third-degree frostbite describes skin that has been damaged though all its layers and tissue that turns black and hard as it dies.
  4. Fourth-degree frostbite occurs when bone and tendon freeze.

It may take many days for the depth of frostbite to cause symptoms and the amount of damage to the tissue may not be known.

Cold is a dangerous element, so do not let hypothermia catch you and if you experience it, seek medical treatment early!

What Are the Signs and Symptoms of Hypothermia?

Symptoms of hypothermia include:

  • Initial hunger and nausea will give way to apathy as the core body temperature drops.
  • The next symptoms develop and are confusion, lethargy, slurred speech, loss of consciousness, and coma.
  • Often the affected person will lie down, fall asleep, and die. Some individuals will paradoxically remove their clothes just before this occurs.

The decrease in brain function occurs in direct relationship to the decrease in body temperature (the colder the body, the less the brain function). Brain function stops at a core temperature of 68 F (20 C).

The heart is subject to abnormal electrical rhythms as hypothermia progresses. Ventricular fibrillation, a disorganized rhythm in which the heart is unable to pump, may occur at core temperatures below 82.4 F (28 C). This is one type of cardiac arrest. This is important to recognize since this irritability and risk of sudden cardiac death may occur when the body is rewarmed.


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Why Do You Take Your Clothes Off When You Have Hypothermia (Paradoxical Undressing)? Can You Die from It?

A phenomenon called paradoxical undressing occurs when the person who is cold undresses instead of trying to bundle up. It is common for a person who is hypothermic to curl up in a snowbank and die. The heart also does strange things when it gets cold. A normal heart rhythm can become irritable and eventually degenerate into ventricular fibrillation (where the bottom chambers of the heart jiggle like a bowl of Jell-O). This lack of electrical impulse does not allow the heart to beat and pump blood to the body and is one of the causes of sudden cardiac death.

Who Gets Frostbite or Hypothermia?

Alcohol consumption is an important risk factor for getting frostbite and hypothermia. Aside from impairing judgment, it may cause blood vessels in the skin to dilate, sending blood to the body's surface where it is exposed to the cold weather causing just the opposite effect of what the body wants to do, which preserves heat. Alcohol also makes shivering less effective, decreasing heat production.

With decreased blood supply to the skin, the far reaches of the body's circulation are at risk for damage. Fingers, toes, ears, and nose are the first parts of the body to be at risk for frostbite. Without adequate blood supply to provide internal heat, water in the tissue can form small ice crystals and the first signs of frostbite begin. The skin may become cold, numb, and hard. The hands or feet can become clumsy and after a time, the skin can blister.

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How Do You Get Frostbite?

Frostbite can affect the nose, cheeks, ears, fingers, and toes (most commonly affected). Risks and causes of frostbite and hypothermia include:

  • Spending a lot of time outside, such as the homeless, hikers, hunters, etc. under extremely cold weather conditions.
  • Those under the influence of alcohol.
  • The elderly without adequate heating, food, and shelter; who are exhausted or excessively dehydrated.
  • The mentally ill.
Reviewed on 2/18/2021

Auerbach P. Wilderness Medicine. 6th edition. United States. Mosby 2011

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