SHM Converge Scientific Abstract ePoster Gallery-(Re)setting the Cold Standard: A Case of Recurrent Hypothermia

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This case describes a 57-year-old man with recurrent idiopathic hypothermia, heart failure on carvedilol, untreated type 2 diabetes, and stage 4 chronic kidney disease who presented with altered mental status and a core temperature of 86.4°F (30.2°C). Initial labs showed leukopenia, renal dysfunction, elevated liver enzymes, and pyuria, prompting ICU admission for possible sepsis and empiric broad-spectrum antibiotics. A workup for reversible causes of hypothermia included evaluation for hypothyroidism, adrenal insufficiency, infection, substance use, pituitary disease, and inborn metabolic errors; imaging and metabolic testing were unrevealing.<br /><br />The authors emphasize that hypothermia can impair metabolism, ventilation, and cardiac output, and that management should include close hemodynamic monitoring because rewarming may worsen hypotension. Medications that interfere with thermoregulation, such as beta-blockers and alpha-adrenergic agonists, should be reassessed. In this patient, carvedilol was held based on literature review. Pharmacologic attempts to restore normothermia included clonidine, cyproheptadine, and clomipramine. Clonidine was stopped because of hypotension, while increasing clomipramine and cyproheptadine reduced the frequency of hypothermic episodes. Because kidney function worsened further, hemodialysis was initiated; after this, he no longer required a warming blanket and his mentation improved steadily. He was discharged three weeks later on clomipramine and cyproheptadine.<br /><br />The key conclusion is that recurrent primary hypothermia is rare but potentially dangerous, contributing to delirium, deconditioning, and hospital complications such as DVT and pneumonia. In selected patients, neuromodulatory agents like clomipramine and cyproheptadine, along with hemodialysis when indicated, may help achieve sustained normothermia and clinical improvement.

Asset Subtitle

Yaser Ahmad

Meta Tag

Author List Allison Hales, Shanu Gupta, Yaser Ahmad

Category Clinical Vignettes

Concept Hypothermia

Concept Initial Evaluation

Concept Diagnostic Workup

Concept Hypothyroidism

Concept Adrenal Insufficiency

Distinguished Non-Finalist

Presenter Organization University of South Florida, Morsani College of Medicine

Presenting Author Yaser Ahmad

Track Adult

Keywords

recurrent hypothermia

idiopathic hypothermia

altered mental status

chronic kidney disease

heart failure

carvedilol

clomipramine

cyproheptadine

hemodialysis

normothermia

Hypothermia

Initial Evaluation

Diagnostic Workup

Hypothyroidism

Adrenal Insufficiency