The effect of blood alcohol on the initial responses to cold water immersion in humans.

Many drowning victims have alcohol in their blood, but it is not clear whether there is a causal relationship. This study examined the effect of moderate alcohol consumption on the initial responses to cold water immersion. Sixteen subjects wearing swimming costumes undertook two, 3-min head-out seated immersions in water at 15 degrees C. One hour before immersion, subjects drank either 3.7 ml.kg body water-1 of 40% v:v alcohol as vodka, or an equivalent volume of water (control) mixed with squash. On immersion, the average blood alcohol concentration was 23 mmol.l-1 (105 mg.100 ml-1) after alcohol consumption and zero in the control condition. Respiratory frequency in the first 20 s of immersion was found to be reduced (P < 0.05) by 10% (a total of 2-3 breaths) after alcohol consumption compared to the control immersion. Tidal volume, heart rate, rectal temperature and skin temperatures did not differ significantly between immersions. It is concluded that moderate alcohol consumption does not attenuate the initial "cold shock" responses to a practically significant extent and is thus unlikely to reduce the risk of drowning on immersion in cold water.

The cold hemiplegic arm.

BACKGROUND AND PURPOSE: Vasomotor changes occur in the arm after hemiplegic stroke. Previous studies have provided conflicting results, with most showing an increase in skin temperature of the hemiplegic arm. However, a number of patients complain of distressing coldness of the hemiplegic arm. METHODS: Eleven patients with symptomatic coldness and 10 patients with hemiplegia but no coldness were recruited. The severity of the symptom of coldness was compared by questionnaire with other common symptoms after stroke. A thermographic camera was used to record the finger skin temperature response to cold stress. Blood flow to both hands was also measured simultaneously by means of two plethysmographs. In all patients there were no symptoms in the unaffected arm, and this was used as a control. RESULTS: The symptom of coldness rated highly compared with other symptoms. In the symptomatic group the finger temperature on the hemiplegic side was lower at rest (median difference at rest, 0.65 degrees C; P < .0001) and at all times after cold stress. In the asymptomatic group the fingers on the hemiplegic side were colder at rest and after initial cooling (median temperature difference, 0.2 degrees C) but at no other time. Hand blood flow on the hemiplegic side was also decreased in the symptomatic group by 35%. This was not seen in the asymptomatic group. CONCLUSIONS: Coldness of the hand may be a severe and distressing symptom in some patients after hemiplegia. Symptomatic patients have lower finger skin temperatures at rest and after standard cold stress. These symptomatic patients also had reduced blood flow to the hemiplegic hand.

The effects of warming by active and passive means on the subsequent responses to cold water immersion.

Two experiments were undertaken to investigate the effects of warming the body upon the responses during a subsequent cold water immersion (CWI). In both experiments the subjects, wearing swimming costumes, undertook two 45-min CWIs in water at 15 degrees C. In experiment 1, 12 subjects exercised on a cycle ergometer until their rectal temperatures (Tre) rose by an average of 0.73 degree C. They were then immediately immersed in the cold water. Before their other CWI they rested seated on a cycle ergometer (control condition). In experiment 2, 16 different subjects were immersed in a hot bath (40 degrees C) until their Tre rose by an average of 0.9 degrees; they were then immediately immersed in the cold water. Before their other CWI they were immersed in thermoneutral water (35 degrees C; control condition). Heart rate in both experiments and respiratory frequency in experiment 1 were significantly (P < 0.05) higher during the first 30 s of CWI following active warming. In experiment 1, the rate of fall of Tre during the final 15 min of CWI was significantly (P < 0.01) faster when CWI followed active warming (2.46 degrees C.h-1) compared with the control condition (1.68 degrees C.h-1). However, this rate was observed when absolute Tre was still above that seen in the control CWIs. It is possible, therefore, that if longer CWIs had been undertaken, the two temperature curves may have converged and thereafter fallen at similar rates; this was the case with the aural temperature (Tau) seen in experiment 1 and the Tau and Tre in experiment 2. It is concluded that pre-warming is neither beneficial nor detrimental to survival prospects during a subsequent CWI.