Thermoregulation

Part 1: Body temperature,

heat production and heat loss

Dr Enoch Chan
Assistant Lecturer
Learning outcomes

At the end of this video, you will be able to:

⎼ Define thermal balance and explain its
importance.
Body temperature

⎼ Body temperature refers to the temperature

of the internal body core, more precisely
known as ‘core temperature’ or ‘core body
temperature’.
⎼ Core temperature can be measured under
the tongue (sublingually), in the ear canal or
in the rectum.

Not an accurate way to

measure core temperature!!
Body temperature

⎼ Core temperature within a narrow

range, usually 36 to 37.5°C.
⎼ Core temperature fluctuates (~1°C)
according to the circadian rhythm
⎼ Highest between 3:00pm and 6:00pm
⎼ Lowest between 3:00am and 6:00am
⎼ The menstrual cycle also causes
slight fluctuation of core temperature
in female.
Core temperature

⎼ Core temperature impacts the rate of biochemical reactions and

activity level.
⎼ Maintaining a stable core temperature frees biochemical reactions
from fluctuating with the temperature of external environment, and
also ensures optimal temperature for biochemical reactions.
⎼ As a result, humans can engage in most normal activities even
when there is significant change in external temperature.
⎼ Large elevations of core temperature are harmful: some people
suffer convulsions at a core temperature of 41°C.
Consequences of deviations
in core temperature
Temperature (°C) Consequence

40 – 44 Convulsions; heat stroke with multiple organ

failure and brain lesions
38 – 40 Hyperthermia (usually caused by fever or
exercise)
36 – 38 Normal range

34 – 36 Mild hypothermia

30 – 34 Impairment of temperature regulation

27 – 29 Cardiac fibrillation
Heat balance

⎼ Body temperature is dependent on the balance

between heat production and heat loss.
⎼ Heat production is a principal by-product of
metabolism.
⎼ Heat loss can occur by:
⎼ Radiation
⎼ Conduction and convection
⎼ Evaporation
Heat production
⎼ Significant proportion of energy is lost as heat when:
⎼ nutrients are metabolised (~35% lost)
⎼ ATP  ADP + Pi (~60% lost)
⎼ Heat is produced mostly in internal body core.
⎼ Factors affecting metabolic rate:
⎼ Basal metabolic rate (for maintaining basic function of all living cells)
⎼ Additional metabolism:
• Increased muscle activity (e.g. shivering, exercise and movements)
• Thyroid hormones and growth hormones
• Epinephrine, norepinephrine and sympathetic stimulation
• Digestion, absorption and storage of food / nutrients (diet-induced
thermogenesis)
Insulating property of the skin

⎼ The skin and subcutaneous

tissues act together as heat
insulator for the body.
⎼ Fats are poor heat conductors.
⎼ The insulation afforded by the
skin and subcutaneous tissues
helps prevent heat loss from the
internal body core.
Guyton and Hall Textbook of Medical Physiology 14e, Figure 74-2
Heat loss from the skin surface

⎼ Heat is transferred from internal

body core to the skin via
circulation.
⎼ Heat is lost from the skin to the air
and other surroundings.
⎼ Rate of heat loss varies:
⎼ A high rate of blood flow to skin
promotes heat transfer from the
internal body core to the skin.
⎼ A reduction in the rate of blood flow Guyton and Hall Textbook of Medical Physiology 14e, Figure 74-2
to skin can minimise heat transfer
from the internal body core.
Heat loss from the skin surface

⎼ Radiation:
⎼ The human body lose heat by
radiating infrared rays.
⎼ The body also gains heat by receiving
infrared rays from surrounding objects
(e.g. the sun, walls, the ground).
⎼ Radiation is a major means of heat
exchange between the body and the
environment.
⎼ When surrounding temperature is
lower than the body temperature, Guyton and Hall Textbook of Medical Physiology 14e, Figure 74-4

heat loss by radiation > heat gain by

radiation
Heat loss from the skin surface

⎼ Conduction:
⎼ The human body loses heat by
conduction to air and objects.
⎼ Heat is conducted to the air through
contact with skin and ventilation
• The heated air is then carried away
and replaced by cool air by
convection (air currents)
• Convection is enhanced by wind
⎼ A small amount of heat is lost to /
gained from objects touching the body Guyton and Hall Textbook of Medical Physiology 14e, Figure 74-4
(e.g. a chair, a bed, the ground).
Heat loss from the skin surface

⎼ Evaporation:
⎼ Heat is lost when water evaporates
from the body surface.
⎼ Insensible water loss: water
evaporates from skin and lungs
even when a person is not sweating
(~600 mL per day).
• This cannot be controlled by the
body
⎼ Evaporation of sweat: can be
controlled by regulating the rate of Guyton and Hall Textbook of Medical Physiology 14e, Figure 74-4
sweating.
Heat loss from the skin surface

⎼ Evaporation is a necessary cooling

mechanism at environments with
high temperature
⎼ When temperature of the environment
> body temperature, the body gains
heat by radiation and conduction
 Evaporation becomes the only
means of heat loss.
Guyton and Hall Textbook of Medical Physiology 14e, Figure 74-4
Clothing insulates the body

⎼ Clothing reduces heat loss by

conduction and convection.
⎼ Clothing traps air next to the skin,
significantly decreasing convection of
air around the skin surface.
⎼ Wet clothes are not effective in
insulating the body.
Emergency blankets

⎼ Emergency blankets (a.k.a. space

blankets) are designed to prevent
heat loss by radiation.
Heat balance

⎼ When heat production > heat loss,

heat builds up in the body and increases body
temperature.

⎼ When heat loss > heat production,

body heat and body temperature decrease.
Thermoregulation

Part 2: Homeostatic regulation

of core body temperature (i)

Dr Enoch Chan
Assistant Lecturer
Learning outcomes

At the end of this video, you will be able to:

⎼ Explain the homeostatic regulation of core body
temperature.
Homeostatic control system

⎼ The body maintains a stable temperature by a homeostatic control

system (neural mechanism).

Effectors:

Behavioural adaptations
Sensor: Control centre: Brown adipose tissue
Thermoreceptors (mostly for infants)
in skin and Posterior
preoptic area hypothalamus skeletal muscle

skin vasculature

sweat glands
Thermoreceptors (sensor)

⎼ The body uses specialised sensory neurons to detect changes in

both core temperature and ambient temperature (air temperature
of the environment).

⎼ Central thermoreceptors are found within the preoptic area of

the hypothalamus – mainly for detecting core temperature.

⎼ Skin thermoreceptors are mainly for detecting changes in

ambient temperature.
Central thermoreceptors (sensor)

⎼ Preoptic area (POA) is located

in the anterior (front) end of
hypothalamus.
⎼ POA contains two types of
thermosensitive neurons:
⎼ Large number of warmth-
sensitive neurons
• Firing rate increases when
body temperature increases
⎼ Smaller number of cold-sensitive
neurons
• Firing rate increases when
body temperature drops
Guyton and Hall Textbook of Medical Physiology 14e, Figure 59-6
Skin thermoreceptors (sensor)

⎼ The skin features sensory nerve fibres for the

detection of temperature change:
⎼ Cold receptor
⎼ Warmth receptor
⎼ Cold receptors are the predominant type of
skin thermoreceptor.
⎼ Cold receptors are stimulated by
temperature drops.
⎼ Warmth receptors are stimulated by
temperature rise.
⎼ Extreme cold / heat can stimulate pain
receptors. Boron and Boulpaep, Medical Physiology 3e, Figure 59-3
Behavioural control of body temperature

⎼ Behavioural control of temperature is a

key mechanism of thermoregulation.
⎼ Examples:
⎼ Choice of surroundings (under the sun? or
under the shade?)
⎼ Changes in clothing
⎼ Change in voluntary activity
⎼ Curling up
⎼ When the brain receives signals from
the central and skin thermoreceptors, it
elicits a sense of hot / cold discomfort,
which nudges behavioural adaptations.
Controlling heat production by
skeletal muscle (effector)

⎼ Muscle activity involves production

and consumption of ATP, hence
generates heat.
⎼ Heat production by skeletal muscle
can be greatly increased by inducing
shivering (involuntary rhythmic
contractions and relaxation).
⎼ Shivering can increase muscle
metabolic rate by more than 2 times.
Controlling heat production by
skeletal muscle (effector)

⎼ Shivering is induced by
motor neurons which relay
signals from the motor
centre in the posterior
hypothalamus.

Guyton and Hall Textbook of Medical Physiology 14e, Figure 59-6

Controlling heat production by
brown adipose tissue (effector)

⎼ Brown adipose tissue has a high density of

mitochondria.
⎼ Key effector for thermoregulation in infants.
⎼ Brown adipose tissue is not prominent in adults.
It is more prominent in infants.
⎼ Mitochondria is the site of oxidative
phosphorylation – the process by which the
breakdown of glucose and fatty acid leads to
the generation of ATP.
Boron and Boulpaep, Medical Physiology 3e,
Figure 59-4 (cropped)
Controlling heat production by
brown adipose tissue (effector)

⎼ Brown adipose tissues are heavily

innervated by the sympathetic
noradrenergic neurons which release
norepinephrine.
⎼ Norepinephrine binds to β3-adrenergic
receptors on brown adipocytes,
promoting the breakdown of
triacylglycerol into fatty acids and
glycerol.

Marks’ Basic Medical Biochemistry: A Clinical Approach, 5e, Figure 24.14

Controlling heat production by
brown adipose tissue (effector)

⎼ The mitochondria of brown adipocytes

express uncoupler protein 1 (UCP1;
also known as ‘thermogenin’).
⎼ Upon activation by fatty acids, UCP1
would uncouple ATP generation from
oxidative phosphorylation.
⎼ The breakdown of nutrients would not
lead to ATP generation. The chemical
energy released will become heat.

Marks’ Basic Medical Biochemistry: A Clinical Approach, 5e, Figure 24.14

Controlling heat production by
brown adipose tissue (effector)

⎼ Hormones like epinephrine and thyroid

hormones also promote heat
production by brown adipose tissues.
⎼ Epinephrine also binds β3-adrenergic
receptors on brown adipocytes to
promote the liberation of fatty acids
and hence activation of UCP1.
⎼ Thyroid hormones can upregulate the
expression of UCP1 by brown
adipocytes.
Marks’ Basic Medical Biochemistry: A Clinical Approach, 5e, Figure 24.14
Control of heat loss in skin (effector)

⎼ Eccrine sweat glands are innervated by

sympathetic cholinergic neurons which
releases acetylcholine, which activates
eccrine sweat gland.
⎼ Eccrine sweat glands can also be stimulated
by circulating epinephrine or norepinephrine
(endocrine) released by adrenal medulla.
⎼ Activation of eccrine sweat glands promotes
the secretion of sweat onto skin surface.

Guyton and Hall Textbook of Medical

Physiology 14e, Figure 74-5
Controlling heat loss in skin (effector)

⎼ The rate of blood flow to the skin

determines the rate of heat transfer from
the core to the skin; i.e., the rate of heat
loss from the skin.
⎼ Rich network of small blood vessels
underneath the epidermis.
⎼ Small arteries / arterioles  capillaries 
veins  venous plexus (under the dermis)
⎼ For the exposed areas of the body (hands,
feet and ears), venous plexus is connected
to small arteries also through arteriovenous
Guyton and Hall Textbook of Medical Physiology 14e, Figure 74-2
anastomoses (AV anastomoses).

Note: anastomosis (singular); anastomoses (plural)

Controlling heat loss in skin (effector)

⎼ The rate of blood flow into the skin

venous plexus vary tremendously
(range: ~0 to ~30% of total cardiac
output).
⎼ This is controlled by the
vasoconstriction (narrowing) or
vasodilation (widening) of the
arterioles and the AV anastomoses.
⎼ Increased vasoconstriction of
arterioles and AV anastomoses
Guyton and Hall Textbook of Medical Physiology 14e, Figure 74-2
reduces heat transfer from internal
body core to the skin.
Controlling heat loss in skin (effector)

⎼ Skin arterioles and AV anastomoses

are controlled by sympathetic
noradrenergic neurons which
releases norepinephrine.
⎼ Norepinephrine binds to α-adrenergic
receptors of arterioles and AV
anastomoses, leading to
vasoconstriction.
Guyton and Hall Textbook of Medical Physiology 14e, Figure 74-2
Thermoregulation

Part 3: Response to temperature change;

fever, hyperthermia and hypothermia

Dr Enoch Chan
Assistant Lecturer
Learning outcomes

At the end of this video, you will be able to:

⎼ Explain the homeostatic regulation of core body
temperature.
⎼ Describe the body changes in pyrexia (fever),
hyperthermia, acclimatisation to heat and
hypothermia.
Thermoregulatory capacity

Effect of high and low atmospheric

temperatures of several hours’ duration,
under dry conditions, on the internal
⎼ The body maintains a stable core temperature body core temperature (in °F).
at a “set point” over a wide range of ambient
temperatures, because of the homeostatic
control systems.

⎼ However, when exposed to extreme °C °F

20 68
temperatures, the heat gained / lost by the body
37 98.6
would overwhelm its thermoregulatory capacity, 45 113
resulting in hypothermia or hyperthermia.

Guyton and Hall Textbook of Medical Physiology 14e,

Figure 74-6
How does the body respond
temperature changes?
Responding to temperature changes

⎼ Increase in core body temperature

⎼ Decrease in core body temperature
⎼ Exposure to high ambient temperature
⎼ Exposure to low ambient temperature
Increase in core body temperature
⎼ Core body temperature > set point
 stimulate Warmth-sensitive neurons in the POA, which send signal to
the posterior hypothalamus, leading to:
• Inhibition of sympathetic noradrenergic neurons which induce
vasoconstriction of skin arterioles and AV anastomoses
 vasodilation of skin arterioles and AV anastomosis
 increased blood flow to the skin
 increased heat loss by radiation and conduction
• (For infants) inhibition of sympathetic noradrenergic neurons that induce
thermogenesis by brown adipose tissue
 decreased heat production
⎼ When the body temperature increase is high, warmth-sensitive neurons in
the POA would also stimulate sweat secretion by eccrine sweat gland
 increased heat loss by evaporation
Decrease in core body temperature
⎼ Core body temperature < set point
 Cold-sensitive neurons in the POA would be activated, they send signal to
the posterior hypothalamus, leading to:
• Stimulation of sympathetic noradrenergic neurons which induce
vasoconstriction of skin arterioles and AV anastomoses
 decreased blood flow to the skin
 decreased heat loss by radiation and conduction
• (For infants) stimulation of sympathetic noradrenergic neurons that
induce thermogenesis by brown adipose tissue
 increased heat production
• Stimulation of motor neurons that induce shivering
 increased heat production
Exposure to high ambient temperature

Skin thermoreceptors work by modulating the activity of warmth-sensitive

neurons in the POA.

When ambient temperature is high:

(core body temperature is still at the set point)
⎼ Skin warmth receptors would be activated, and they would stimulate the
activity of warmth-sensitive neurons in the POA.
 increased blood flow to the skin  increased heat loss
 (for infants) decreased heat production by brown adipose tissue

⎼  prevents increase in core body temperature

Exposure to low ambient temperature

When ambient temperature is low:

(core body temperature is still at the set point)
⎼ Skin cold receptors are activated, they would inhibit the activity of warmth-
sensitive neurons in the POA.
 decreased blood flow to the skin  decreased heat loss
 shivering  increased heat production.
 (for infants) increased heat production by brown adipose tissue
 prevents decrease in core body temperature
Thermoregulation in infants, adults and elderly

Newborns / infants: Adults:

⎼ do not readily shiver or sweat. ⎼ can readily shiver or sweat
⎼ are small in size, hence much ⎼ can cause vasoconstriction of skin
higher surface-to-mass ratio, so arterioles and AV anastomoses
their core temperatures are more ⎼ have minimal amount of brown
prone to changes when exposed to adipose tissue (modest effect on
hot or cold environments regulating heat production)
⎼ have modest ability to cause
vasoconstriction of skin arterioles Elderly:
and AV anastomoses ⎼ Less able to sense heat and cold
⎼ have large deposits of brown ⎼ Reduced ability to generate heat
adipose tissue (significant effect on and dissipate heat
controlling heat production)
Fever, hyperthermia and
hypothermia
Fever vs hyperthermia

⎼ Fever (pyrexia) is an increase in core body temperature

due to an elevation of the thermoregulatory set point.

⎼ Hyperthermia refers to an increase in core body

temperature above the set point, while the set point
itself did not change.
Fever
⎼ Fever can be induced by bacterial / viral infection (most
common cause), physical trauma or tissue damage.
⎼ In response to exogenous pyrogens (e.g. lipopolysaccharide
from Gram-negative bacteria), macrophages release cytokines
(e.g. IL-1β, IL-6 and TNF-α) to the circulation.
 increased production of prostaglandin E2 (PGE2) in the brain
 PGE2 acts on the preoptic area to increase the set point
⎼ The body’s response (same as when core temperature is
decreased):
⎼ decreased blood flow to the skin  decreased heat loss
⎼ increased shivering  increased heat production
 increase in core body temperature
⎼ Antipyretic drugs like aspirin or ibuprofen reduce fever by
inhibiting the production of PGE2.
Hyperthermia

Hyperthermia can result from one or more of the following:

⎼ Strenuous exercise
⎼ Increased skeletal muscle activity  increased heat production
⎼ High ambient temperature
⎼ Increased heat gain from / reduced heat loss to the environment
⎼ High ambient humidity
⎼ Decreased rate of evaporation of sweats  reduced heat loss

As the body responds by profuse sweating:

⎼ The body loses water and salt
 weakness, nausea and sometimes fainting (heat exhaustion)
Hyperthermia

⎼ When core body temperature

increases beyond a critical point,
heatstroke is likely to occur.
⎼ Heatstroke involves a complete
breakdown of the thermoregulatory
systems (e.g. failure to sweat),
leading to continued increase in
the core temperature.
⎼ Leading to signs such as collapse,
delirium, seizures or prolonged
unconsciousness.
Acclimatisation to heat

When a person is exposed to hot weather for an extended

period (1 to 6 weeks):
⎼ They begin to sweat more profusely and become better able to
lose heat.
⎼ Their sweats also have lower concentration of sodium chloride,
due to increased aldosterone secretion by adrenal cortex.
⎼ As a result, they lose less salt from sweating, hence less likely
to experience weakness due to excessive loss of salt.
Hypothermia

⎼ A common situation causing excessive hypothermia

is prolonged immersion in cold water.
⎼ Water has much greater specific heat capacity and
thermal conductivity than air.
⎼ Alcohol intoxication is also often associated with
hypothermia, because ingestion of alcohol causes
vasodilation of skin blood vessels. An iconic scene in the ‘Titanic’ movie
⎼ As a result, the body could not overcome the heat
loss, leading to significant decrease in core
temperature.
⎼ Severe hypothermia can lead to impaired
consciousness or cardiac arrest.
Learning outcomes

At the end of this video, you will be able to:

⎼ Define thermal balance and explain its
importance.
⎼ Explain the homeostatic regulation of core body
temperature.
⎼ Describe the body changes in pyrexia (fever),
hyperthermia, acclimatisation to heat and
hypothermia.
References
Boron and Boulpaep, Medical Physiology, 3rd Edition
⎼ Ch 59
Guyton and Hall Textbook of Medical Physiology, 14th Edition
⎼ Ch 74
Online access available via HKU Library (ClinicalKey)

Vender’s Human Physiology, 13th Edition

⎼ Ch 16 (sections 16.4 to 16.7)