In the infant, hypothermia can be manifested as which of the following?

In the infant, hypothermia can be manifested as which of the following?

• A. Metabolic acidosis
• B. Prolonged duration of action of nondepolarizing muscle relaxants
• C. Hypoglycemia
• D. All of the above

Answer: (D)

In infants, hypothermia disrupts metabolism and drug handling in several interconnected ways, so multiple problems can arise at once. First, cooling promotes tissue hypoxia and a shift toward anaerobic metabolism, which leads to lactic acid buildup and metabolic acidosis. The cold also causes vasoconstriction and can reduce tissue perfusion, further contributing to acidosis from impaired oxygen delivery and clearance of metabolic byproducts. Second, temperature critically affects drug metabolism and clearance. Nondepolarizing muscle relaxants are broken down and eliminated more slowly when the body is cold, so their effects linger longer than expected. This prolongation is especially important in neonates whose organ systems are already limited in capacity and more sensitive to temperature changes. Third, glucose management is tightly tied to heat generation. Infants have limited glycogen stores, and generating heat increases glucose consumption. Under hypothermia, this higher metabolic demand can outpace supply, producing hypoglycemia unless glucose intake is adequate. Because these mechanisms can occur together, hypothermia in the infant can manifest as metabolic acidosis, prolonged duration of action of nondepolarizing muscle relaxants, and hypoglycemia—all of which can occur in the same patient.

In infants, hypothermia disrupts metabolism and drug handling in several interconnected ways, so multiple problems can arise at once. First, cooling promotes tissue hypoxia and a shift toward anaerobic metabolism, which leads to lactic acid buildup and metabolic acidosis. The cold also causes vasoconstriction and can reduce tissue perfusion, further contributing to acidosis from impaired oxygen delivery and clearance of metabolic byproducts.

Second, temperature critically affects drug metabolism and clearance. Nondepolarizing muscle relaxants are broken down and eliminated more slowly when the body is cold, so their effects linger longer than expected. This prolongation is especially important in neonates whose organ systems are already limited in capacity and more sensitive to temperature changes.

Third, glucose management is tightly tied to heat generation. Infants have limited glycogen stores, and generating heat increases glucose consumption. Under hypothermia, this higher metabolic demand can outpace supply, producing hypoglycemia unless glucose intake is adequate.

Because these mechanisms can occur together, hypothermia in the infant can manifest as metabolic acidosis, prolonged duration of action of nondepolarizing muscle relaxants, and hypoglycemia—all of which can occur in the same patient.