Early mechanical ventilation will prevent respiratory collapse and severe respiratory acidosis.
Often intravascularly depleted
May have underlying illness causing dehydration
In patients who are hyponatremic, be cautious with rapid correction of hyponatremia
Consider fluid restriction
Use D5NS if hypoglycemic
Monitor for unmasking of CHF
May have underlying illness causing dehydration
Consider fluid restriction
Vasopressors will be ineffective without concomitant thyroid hormone replacement
Levothyroxine (T4) (generally agreed upon first line therapy)
Dose: 100 to 500 mcg (4mcg/kg IV) followed by 75 to 100 mcg administered IV daily until the patient takes oral replacement.
Does require extrathyroidal conversion which can be reduced in<unk>  but will have a slow steady onset of action
Potentially safer in patients with CAD
American Thyroid Association recommends treatment with both T4 and T3
T3 5-20mcg IV followed by 2.5-10mcg q8hr 
Start with 10mcg if elderly or has CAD
Does not require extrathyroidal conversion
More rapid onset but may be harmful in patients with CAD
Dose: 100 to 500 mcg (4mcg/kg IV) followed by 75 to 100 mcg administered IV daily until the patient takes oral replacement.
Does require extrathyroidal conversion which can be reduced in<unk>  but will have a slow steady onset of action
Potentially safer in patients with CAD
American Thyroid Association recommends treatment with both T4 and T3
Start with 10mcg if elderly or has CAD
Does not require extrathyroidal conversion
More rapid onset but may be harmful in patients with CAD
Hydrocortisone 100 mg IV q8h for possible concomitant adrenal insufficiency
Alternative: dexamethasone 2-4mg q12hrs (will not affect cortisol level or ACTH stimulation test)
Alternative: dexamethasone 2-4mg q12hrs (will not affect cortisol level or ACTH stimulation test)
Treat with passive rewarming
Hypothermia will also reverse with thyroid hormone administration
Avoid mechanical stimulation
Do not actively rewarm:
Usually are volume depleted
Rapid peripheral vasodilation may induce worsening hypotension
Usually are volume depleted
Rapid peripheral vasodilation may induce worsening hypotension
Myxedema coma
Adrenal crisis
Spinal shock
CHF
Neurogenic shock
CVA
Heat stroke
Depression