• Human beings are remarkably adaptable animals - can maintain homeostasis near the equator,

where the year-round temperature averages 27°C, and near the poles, where the temperature
remains below 0°C most of the time.

 The key to survival under such varied environmental conditions is the ability to preserve normal body
temperature.

• Human bodies have anatomical and physiological mechanisms that keep body temperatures
within acceptable limits, regardless of the environmental conditions.

• This homeostatic process is called thermoregulation.

• Failure to control body temperature can result in a series of physiological changes .

Temperature (ºC) Physiological changes

< 37 disorientation, muscle failure, loss of body temperature control

37 normal

> 37 CNS breakdown, coma, DEATH

• We are constantly generating heat as a byproduct of cellular metabolism, released from chemical conversion
of foods to ATP.
• On average, 35% of the energy from food becomes heat - that heat must be lost to the environment at the
same rate if body temperature is to remain constant.

Activity Energy produced

(Cal/m2hr)

sleeping 35
sitting 50
standing 85
dressing 100
walking (3mph) 140
bicycling 250
swimming 350
running 600

• When the environmental conditions vary from "ideal," - too warm / too cold, the body must control
the gains or losses to maintain homeostasis.
 Types of body temperature

 core body temperature

- temperature of deep tissues; the liver, heart,GIT , brain, skeletal muscles.

- almost exactly constant
- fluctuates very little in healthy adults - except when the person develops a febrile illness.
- critical range / set point = 36.7 ºC - 37.1 ºC

> 37.1 ºC  the rate of heat loss is greater than heat production.
 the body temperature  & returns to normal.

< 37.1 ºC  the of heat production > heat loss

 the body temperature  & returns to normal
 surface / “shell” temperature

- temperature of the surface of the body; skin, subcutaneous tissues & fat.
- fluctuates widely in healthy adults
- minimum ~ early morning
- maximum ~ early evening
- also depends on the body size & activity
- range = 20 ºC - 40 ºC

Normal range of body temperature

infant : 36.1 ºC - 37.7 ºC

child : 37.0 ºC - 37.6 ºC
Orally ; + 1 ºC rectally
adult : 37.0 ºC - 37.6 ºC
older adult : 36.0 ºC - 36.9 ºC
 Mechanisms of Heat Transfer

• Heat exchange with the environment involves four basic processes:

RADIATION

- transfer of heat from one surface to another without contact between two
surfaces, mostly in the form of infrared rays
- Over half the heat lose is attributable to radiation
eg. 60% of total heat lost from the body of a nude person at a room temperature
is the result of radiation of heat from the person into the room.

CONDUCTION

- direct transfer of heat through direct physical contact between the two surfaces
- 15% of total heat lost

NOTE: CONVECTION
Heat flows down its concentration gradient;
WARMER  COOLER REGION
- dissipation of heat by air currents
EVAPORATION

- dissipation of heat by transformation of water to a vapor.

- Evaporation absorbs energy, roughly 0.58 C per gram of water evaporated.
- The rate of evaporation occurring at the skin is highly variable.
- Each hour (x sweating), 20-25 ml of water crosses epithelia and evaporates from the alveolar surfaces and the skin.
- This insensible perspiration remains relatively constant; at rest it accounts for roughly one-fifth of your average heat loss.
- The sweat glands responsible for sensible perspiration have a tremendous scope of activity, ranging from virtual inactivity to

secretory rates of 2-4 liters per hour

PANTING

- rapid breathing with open mouth, at frequency at 200 – 400 breaths/min

- important in many animal species;
a) Body surfaces covered with fur
b) Little (cats, rhinocerous - ventral part) / no sweat glands (dogs, birds..)

- usually accompanied by increased salivation as well as increased in respiratory evaporative cooling if the humidity of the
inspired air is not too high.
- birds increased evaporation not only by panting but also by a mechanism called gular flutter; rapid oscillations of the thin
floor of the mouth and the upper part of the throat.
 CONTROL OF BODY TEMPERATURE

• Regulation of body temperature is a complex physiologic process maintained through central interactive
function of the hypothalamus.

• depends on 3 components:-
 Thermoreceptors
 Thermoregulatory center
 effectors
THERMORECEPTORS

• 2 types:-

 peripheral tissues thermoreceptors

- located in the skin, spread uniformly across the skin
- contribute to our perception of temperature
- send information regarding the external environment to the thermoregulatory center

 deep body tissues thermoreceptors

- temperature sensitive neurones – clustered in the preoptic area of the anterior hypothalamus, along spinal cord,
the great vessels and abdominal viscera.
- send information regarding internal environment to the thermoregulatory center.
• both types have cold & warmth receptors.
• warm receptors are activated ~ 30 ºC, and increased its firing rate until about 45 ºC.
• 45 ºC – is the point where thermal nociceptors begin firing; it is also where perception changes from hot to
scalding, & tissues begin to burn.

• cold receptors are activated ~ 1 - 10 º below normal skin temperature

• cold receptors > warm receptor (10:1) – more concerned with preventing hypothermia!!!!!!

• The responses of thermoreceptors adapt during long-duration stimuli.

38 ºC 38 ºC
• Sudden drop in skin temperature causes a cold receptor to fire strongly, while it
silences a warm receptor.
32 ºC Skin temperature (ºC)
• After few secs, at 32 º, the cold receptor slows its firing (but still faster it did at
38 º), while the warm receptor seeds up slightly.
action potential
• Return to original warm skin temperature causes opposite responses; transient
silence of the cold receptor, & a burst of activity in the warm receptor – before
both return to their steady rates.

Cold receptor

warm receptor

5 sec
 THERMOREGULATORY CENTER

• Temperature control is coordinated by the HEAT-LOSS CENTER & HEAT-GAIN CENTER, located in
the preoptic area of the hypothalamus – also known as “body’s thermostat”.

• This area contain large number of heat-sensitive neurones (HSN)

& cold-sensitive neurones (CSN).

• Heat-loss & heat-gain center receives input from thermoreceptors

– activated when body temperature below / above the critical set
point, respectively.

• The overall effect is to control temperature by influencing 2 events:

 The rate of heat production

 The rate of heat loss

EFFECTORS

 blood vessels/smooth muscle

 sweat glands
 skeletal muscle
 MECHANISMS FOR INCREASING HEAT LOSS

• When the temperature at the preoptic nucleus exceeds its thermostat setting, the heat-loss center is stimulated.
• Stimulation of this center has 4 major effects:

 VASODILATION
- Inhibition of the vasomotor center causes peripheral vasodilation
- warm blood flows to the surface of the body.
- The skin takes on a reddish color, skin temperatures rise, and radiational and convective losses increase.

 SWEATING
- As integumentary blood flow increases, sweat glands are stimulated to increase their secretory output.
- The perspiration flows across the body surface, and evaporative losses accelerate.
- A maximal secretion rate would, if it were completely evaporated, remove ~ 2300 C per hour.

 RESPIRATION
- The respiratory centers are stimulated, and the depth of respiration increases.
- Often the individual begins respiring through an open mouth rather than through the nasal passageways, increasing
evaporative losses through the lungs.
  HEAT PRODUCTION DECREASED
- The mechanisms that cause excess heat production, such as shivering and chemical thermogenesis are strongly inhibited.

MECHANISMS FOR PROMOTING HEAT GAIN

• The function of the heat-gain center of the brain is to prevent hypothermia, or below-normal body temperature.
• When the temperature drops below acceptable levels,

• heat-loss center - inhibited,

• heat-gain center - activated.

Heat Conservation.
-The sympathetic vasomotor center decreases blood flow to the dermis of the skin, thus reducing radiational, convective,
and conductive losses.

-The skin cools, and with the circulation restricted, it may take on a bluish or pale coloration.

-The epithelial cells are not damaged, because they can tolerate extended periods at temperatures as low as 25°C or as
high as 49°C (120°F).
• In cold weather, blood returning from the extremities is shunted into a network of deep veins that lie beneath an
insulating layer of subcutaneous fat.

• This venous network wraps around the deep arteries.

• Heat diffuses from the warm blood flowing outward to

the limbs into the cooler blood returning from the
periphery.

• This arrangement traps the heat close to the body

core and restricts heat loss by reducing the
temperature gradient between the arterial blood and
the outside world.

• Diffusion between fluids that are moving in opposite

directions is called COUNTERCURRENT HEAT
EXCHANGE
• Countercurrent heat exchange occurs as heat radiates from the warm
arterial blood into the cooler venous blood flowing in opposite direction.

• By the time the arterial blood reaches distal capilaries where most of
the heat loss to the environment occurs, it is already 13 ºC cooler than
it was when it left the trunk.

• This mechanism reduces the rate of heat loss while conserving heat.

• In effect, the countercurrent exchange traps heat near the trunk.

 Heat Generation

• The mechanisms to generate heat can be divided into two broad categories:

 shivering thermogenesis

 nonshivering thermogenesis.

Shivering thermogenesis

• a gradual increase in muscle tone increases the energy consumption of skeletal muscle tissue

• Both agonists and antagonists are involved, and the degree of stimulation varies with the demand.

• If the heat-gain center is extremely active, muscle tone increases to the point at which stretch receptor

stimulation will produce brief, oscillatory contractions of antagonistic muscles = shiver

• Shivering increases the workload of the muscles and further elevates oxygen and energy consumption.

• The heat that is produced warms the deep vessels.

• Shivering can elevate body temperature by as much as 400 percent.

 nonshivering thermogenesis

• hormones are released that increase the metabolic activity of all tissues:

(1) Epinephrine

 The heat-gain center stimulates the adrenal medullae, via the sympathetic division of the
ANS, and epinephrine is released.

 Epinephrine increases the rates of glycogenolysis in liver and skeletal muscle and the metabolic rate of
most tissues.

 These effects are immediate.

(2) Thyroxine

 The preoptic nucleus controls the production of TRH by the hypothalamus.

 The thyroid gland responds by increasing the rate of thyroxine release into the blood.

 Thyroxine increases not only the rate of carbohydrate catabolism but also the rate of catabolism of all
other nutrients.

 These effects develop gradually, over a period of days to weeks.

 BEHAVIOURAL MECHANISMS

 Removing clothing - dressing for warm weather

 decreasing physical activity - slow down

 increasing the amount of skin surface available for heat loss

 moving to a cooler environment…….etc

THERMOREGULATION IN INFANTS

• Infants have problems with thermoregulation ;

• high surface-to-volume ratios.

• temperature-regulating mechanisms are not fully functional.

• With high surface-to-volume ratios, newborns must be dried quickly and kept bundled up;

• Infants' body temperatures are also more unstable than those of adults.

• Their metabolic rates decline when they are sleeping, then rise after arousal.
• Infants cannot shiver, but they have a different mechanism for raising body temperature rapidly.

• The adipose tissue between the shoulder blades, around the neck, and elsewhere in the upper body is
histologically and functionally different from most of the adipose tissue in the adult.

• The tissue is highly vascularised, and the individual adipocytes contain numerous mitochondria.

• Together these characteristics give the tissue a deep, rich color responsible for the name brown fat.

• The individual adipocytes are innervated by sympathetic autonomic fibers.

• When these nerves are stimulated, lipolysis accelerates in the adipocytes.

•The heat released, radiates into the surrounding tissues & quickly warms the blood that passes through the
surrounding network of vessels, and it is then distributed throughout the body.

• In this way, an infant can accelerate metabolic heat generation by 100 percent very quickly, whereas
nonshivering thermogenesis in the adult will raise heat production by only 10-15 percent after a period of
weeks.

• With increasing age and size, body temperature becomes more stable, and the importance of this
thermoregulatory mechanism declines.
 ACCLIMATISATION TO HEAT

• process of adaptation to a new environment.

• This may take the form of adaptation from a cold to a hot environment, from a hot to a hot humid
environment or from a hot to a cold environment.

• In general terms, the adaptation from a hot or hot humid environment to a cooler environment is
less of a problem.

• 2 types:-

• Passive - a result of living in a hot climate (1-3 weeks)

• Active - a result of exercising in a hot environment (5-10days)

• Physiological changes that occur during the process:-

•  in the rate of sweating (~ twofold than normal rate)
•  in the plasma volume
• loss of electrolytes in the sweat & urine to relatively very little / almost none
• Increased metabolic efficiency (less heat produced)

• > important for domestic animals – production & breeding, sports

 THERMOREGULATORY VARIATIONS AMONG ADULTS

• Adults of the same body weight may differ in their thermal responses.
• Factors influencing :-

• surface - to- volume ratio

- 70 kg & 1m tall vs 70 kg & 2 m tall
• subcutaneous fat
- adipose tissues - excellent insulator

• hormone level
- healthy woman, during ovulation - progesterone level relatively high, rises CBT
as much as 0.3 ºC - 0.5 ºC
• environmental acclimatisation
• exercise
• infection
• hypothalamic thermostat - different setting
• stress - result in secretion of adrenaline & noradrenaline - increase metabolic rate
 ABNORMALITIES OF THERMOREGULATION

• The limits of extreme heat that one can stand depend on:
• temperature
• humidity

• Overexposure to high temperatures and humidity can quickly lead to heat illnesses :-
• Heat Cramps
• Heat Exhaustion due to heat and dehydration
• Heat Stroke - a life threatening condition

Heat Cramps

• Heat cramps are muscle spasms which usually affect the arms, legs, or stomach.
• Frequently occur until sometime later after work, at night, or when relaxing.
• Heat cramps are caused by heat, dehydration, and poor conditioning, rather than to lack of salt /
other mineral imbalances.
• Although it can be quite painful, they usually don't result in permanent damage
• improve with rest, drinking water, and a cool environment.
 Heat Exhaustion

• > serious than heat cramps.

• occurs when the body's heat loss mechanisms overworked, but hasn't completely shut down.
• The peripheral blood vessels and capillaries which originally enlarged to cool the blood collapse
from excessive loss of body fluids and necessary minerals.

• The symptoms include:

• headache, • fatigue, • loss of appetite,

• heavy sweating, • loss of coordination, • hyperventilation,
• intense thirst, • nausea, • anxiety,
• dizziness, • impaired judgment, • weak and rapid pulse (120-200),
• low to normal blood pressure.
• Treatment:

- shady place or AC room

- keep cool
- increase fluids intake
- cold wet towels
- may require IV fluids
 Heat Stroke

• a life threatening illness with a high death rate.

• occurs when the body has depleted its supply of water and salt, and the body temperature rises
to deadly levels.

• A victim may first suffer heat cramps and/or the heat exhaustion before progressing into the heat
stroke stage

• The early symptoms :-

• a high body temperature (> 40 °C)
• a distinct absence of sweating (usually)
• hot red or flushed dry skin
• rapid pulse
• difficulty breathing
• constricted pupils

• any/all the signs or symptoms of heat exhaustion such as dizziness, headache, nausea, vomiting,
or confusion
• more severe;
• bizarre behavior
• high blood pressure
• seizure or convulsions,
• collapse
• loss of consciousness,
• body temperature of over 42 °C.

• Tx :
• ice packs – to reduced temperature quickly
• IV fluids for rehydration
• shady place or AC room
• Remove most of clothes
• fan to increase air flow
• transport to ER
 Fever / Pyrexia

• An elevated core body temperature above normal range

• may occur for a variety of reasons, not all pathological.
• In young children, transient fevers with no ill effects may result from over active.

• May results from:-

• abnormalities of the entire thermoregulatory mechanism
• circulation problems - eg. Congestive heart failure
• impairment of sweat gland activity - drug reaction/skin problem
• resetting of the hypothalamic thermostat by circulating pyrogen - Interleukin-1

• PYROGEN???

- toxin secreted by bacteria / foreign substances from degenerating tissues of the body /
breakdown products of bacteria
 • Types of fever:-

(a) constant fever

- rise in temperature above normal - remains consistently high with little / no
fluctuation.

(b) intermittent fever

- rises in temperature above normal at some point during 24 hrs period

(c) relapsing fever

- rises in temperature lasting for several days, alternating with several days of normal
temperature

Phases of fever

(1) Onset (cold / chill) phase

- “resetting” of the hypothalamic thermostat to a new higher set point - eg. Infection, dehydration
- heat gain center activated - mechanisms for promoting heat gain are attempting to
increase the CBT until the temperature at the preoptic center reach new setting.
 Signs of the onset phase :-

•  heart rate
•  respiration rate & depth of respiration
• Feeling cold - cold skin due to vasoconstriction
• shivering
• cyanotic nail buds due to vasoconstriction
• cessation of sweating
• rise in CBT

(2) Fever phase

- occurs when the temperature have reached the new, higher set point

Signs of the fever phase :-

• absence of chills • mild to severe dehydration

• feeling of neither hot/ cold • simple drowsiness, restlessness
• skin warm • loss of appetite
•  thirst • malaise, muscle weakness, aching muscles
(2) flush/crisis phase

- occur when the mechanism for heat loss are attempting to decrease the CBT to a new, lower
set point due to sudden removal of the cause of the high temperature

Signs of the flush phase :-

• skin appears flushed and feels warm

• sweating
• decreased shivering
• normal CBT
Common interventions for fever:-

- antipyretics - eg. Paracetamol, ibuprofen - reduces set point to lower level

- antibiotics - destroys m/organisms
- oxygen - 7% increase in oxygen consumption for each degree in rise of temperature
- hypothermia blanket - increases heat transferred to the blanket
-  cool fluid intake - 2L -3L/day
- increase air circulation -  heat loss through convection
-  physical activity
 FOREIGN SUBSTANCES

leucocytes
Release into the blood circulation
• macrophages
• lymphocytes

Interleukin-1
Also called leucocytes
pyrogen / endogenous
pyrogen

Prostagladin E2
- antipyretic drug E.g.. paracetamol, aspirin
-
preoptic center of •  thermostat setting
the hypothalamus

+
• heat production
heat-gain center
• heat conservation

}
• individual feels cold Continue until the temperature at the
• shivering preoptic center corresponds to the new
• vasoconviction setting
 HYPOTHERMIA

• body temperature reduced below normal range

• 2 types:-
• induced / artificial hypothermia
• accidental hypothermia

induced / artificial hypothermia

• intentionally produced to a range of 25 ºC - 32 ºC

• to reduce the metabolic rate, need for oxygen and blood loss of a particular organ or of the
entire body. Eg. Open heart surgery / neurologic surgery

• In controlled hypothermia, the individual is first anesthetised to prevent the shivering that would
otherwise fight the process.

• When cardiac surgery is performed on infants, a deep hypothermia is produced by cooling

the entire body to temperatures as low as 11°C for an hour or more
 accidental hypothermia

• exposure to extreme cold environment or immersion in cold water

• symptoms :-

• low body temperature below normal range

• at 35 °C -  respirations, shivering, poor judgement

• 35 °C - 34 °C - bradycardia / tachycardia, dyshythmias, muscle rigidity, lethargy

• 34 °C - 30 °C - bradycardia, hypoventilation, generalised rigidity, metabolic acidosis, coma

• < 30 °C - no apparent vital signs, coma, cyanotic, dilated pupil, appearance of death
~ At this point, the individual probably assume dead. But because metabolic activities
have decreased systemwide, the victim may still be saved, even after several hours
have elapsed.
• Tx:-
• remove from the cold, wet clothing & keep dry
• cardiopulmonary support
• gradual rewarming, both external and internal.
~ The skin can be warmed up to 45°C without damage; warm baths or blankets
~ One effective method of raising internal temperatures involves the introduction of warm
saline solution into the peritoneal cavity.
• In severe case - rewarming through hemodialysis

Frostbite

• freezing of the skin surface areas and/or the bodily tissues under the skin

• most often occurs in the ear lobes, nose, face, digit of the hands & feet

• due to formation of ice crystal in the cells (H 2O expands ~ 7% during freezing) – cell membrane
are destroyed in the process.

• This can cause damage to the blood vessels and result in blood clotting and lack of oxygen to
the affected area.

• Serious cases have been known to kill and damage tissue to the extent that amputation required.