High Altitude Hypothermia Reversal in the Field: A Case from Northern Pakistan, Karakoram Range.

Severe accidental hypothermia is a well-recognized risk in high altitude environments, where sudden weather changes, prolonged exposure to unstable temperatures, and limited medical access can rapidly become life threatening. In remote areas such as the Karakoram Range of northern Pakistan, improvised rewarming techniques may be the only viable option until evacuation is possible. We report a case of a 32-y-old healthy male trekker who was found unresponsive by his companions at ∼4200 m in the Karakoram Range with a recorded axillary temperature of 27°C, measured using a portable low-reading thermometer (Braun digital). At the time of discovery, the estimated ambient temperature was approximately -10°C with sustained winds of 15 to 20 km/h, contributing to significant cold exposure. The patient was bradycardic with a heart rate of 32 beats/min, hypotensive with blood pressure of 70/40 mmHg, respiratory rate of 8 breaths/min, and unconscious with a Glasgow Coma Scale score of 6/15 (E1 V1 M4). On assessment, he was cold to touch with rigid extremities and weak peripheral pulses, findings consistent with moderate to severe hypothermia. He was initially unresponsive and then only responded to stimulation by groaning. Because of delayed access to formal medical care, the trekking team initiated field rewarming using improvised methods such as heated rocks wrapped in cloth applied to axillae and groin, insulation with multiple clothing layers and foil blankets, and intermittent truncal body-to-body contact. Over a few hours, his temperature increased to 34°C. He became alert and oriented to person and place, with heart rate rising to ∼60 beats/min, blood pressure improving to ∼100/60 mm Hg, and respiratory rate normalizing to 16 breaths/min. The team subsequently evacuated him to a local medical facility, where he recovered fully without neurologic deficits. This case demonstrates that simple physiology-based rewarming measures can be effective in reversing hypothermia when advanced equipment is unavailable. Early insulation with active external rewarming can be effective in treating hypothermia in austere settings. We recommend basic cold injury training for trekking teams.