Hypothermia in colder climates in the United States occurs predominately as a result of exposure of alcoholics to cold outdoor temperatures. Among 24 cases of accidental hypothermia occurring at a university medical center in the deep South, differences in clinical presentation were identified. In contrast to experience in colder climates, 17/22 cases (76%) developed at home. Alcohol was a factor in only 8/24 (33%). The elderly were at greatest risk, accounting for 16/24 patients (65%). Factors suggested to account for the high incidence of hypothermia in the elderly include abnormal temperature perception or regulation, intercurrent illness, social isolation, inadequate housing, and poverty. Coexisting medical conditions were identified as a potential cause of hypothermia in only 10/24 of these patients (42%). Social isolation was not a strong predictor, with 6/17 of the elderly (35%) living alone. Death occurred in 9/24 patients (37%), but survival could not be predicted from admission temperature, hypotension, anemia, or serum glucose. Since extreme cold temperatures are infrequent in the deep South, identified differences in demographics may be due to inadequate housing or lack of preparation for cold weather dangers.