Hypothermia, inside the unit, any ideas?

[Finallydidit]

45 yom, 400+ #s, admitted 13 yrs ago, w/ head injury d/t mva. paralized from waist down., stable condition, mentally challenged, but able to remember names, faces, etc. difficult to understand but can ask questions. VS tend to run on the low side of normal.

Go into shift yesterday, and CNA's tell me thay can't get a temp. on him but thermometer is working fine on everyone else. Go in pull off covers and Resident is cold to touch, His breath was even cold, BP is 88/52 pulse is 44, find another thermometer and get an aux of 88.7... SEND HIM OUT!!!

Got a call from hosp. admitted to ICU for profound hypothermia. Got a rectal temp of 90. said he has a UTI, which we were aware of and he was being treated with abt.

How does this happen any ideas? I have never seen anything like this and I am very curious, as is everyone else on my unit.

Now mind you, the Res never leaves the unit, let alone go outside, he also has a roommate who is fine.

So throw your ideas at me

Thanks so much

[kathy313]

It's possible he had a stroke.

[kathy313]

Maybe sepsis.....just seen the statement about the UTI.

[AnnieNHRN]

Pts with spinal cord injuries have a harder time regulating their temperature, especially when their fighting an infection.

He might have a brain stem injury/stroke, which would cause temp control issues.

[HeyHeyitsMaay]

My very first thought also is brain injury. That's the only thing that fits. That's where temp. regulation takes place.

[Emergency RN]

maybe sepsis.....just seen the statement about the uti.

i'm inclined to agree.

it may be sirs (systemic inflammatory response syndrome), except for the bradycardia (one expects it to be above 90 in sirs but with an elderly person, perhaps in heart block, this may be moot). the fact that he's being treated for a urinary tract infection leans suspicion in this direction as the uti may have gone systemic. further if his white blood cell count drops or becomes elevated then that's generally another sign of inflammatory response syndrome.

while hypothermia may be used in the initial treatment of stroke, i personally don't believe that it's widely accepted, in and of itself, as sign for cerebral vascular accident (cva).

regarding previous brain or cord injury, imho, the accident that left him partially paralyzed is moot in this case. he's been a resident there for 13 years and there was no indication (as least not in the op's notation) that he had problems with thermoregulation until that day. so whatever it was, it was something acute and was not secondary to some chronic aspect of his physiology.

[Finallydidit]

Regarding previous brain or cord injury, IMHO, the accident that left him partially paralyzed is moot in this case. He's been a resident there for 13 years and there was no indication (as least not in the OP's notation) that he had problems with thermoregulation until that day. So whatever it was, it was something acute and was not secondary to some chronic aspect of his physiology.

No problems at all until I went to work yesterday morning. Also forgot to mention that pupils (2mm) were very sluggish to react, if at all, meaning in my assessment, I didn't see any reaction, or response another nurse thinks they did, but were slow. Also his alertness was wnl for him, and he understood that we were sending him to the hospital. So cognitively he was pretty much normal.

I work tonight, I will post any report that I get, and Thank you guys so much for your insight.

[mskate]

2 ideas - cold sepsis being the first one with his spinal cord injury and active UTI. Being hypothermic can also cause those neuro changes. My second thought would be a new stroke, considering his decreased LOC and pupillary changes. Probably lean more towards the sepsis though. Not all septic patients get febrile - sometimes, they get reeeaalllyyy cold.

[CoffeeRTC, BSN, RN]

I vote for sepsis, septic shock...

[PostOpPrincess, BSN, RN]

R/O sepsis.

Patient has gone from normothermic to hypothermic, bypassing the SIRS hyperthermic stage probably related to an ongoing ABX treatment, and perhaps, just perhaps some thermoregulatory issues.

I'm just basing this on those numbers alone. Bradycardia is probably related to the decrease in temp--compare that to being "frozen"--everything slows down--"hypodynamic." as it were.

Bottom line: cold sepsis.....wonder if he is in MODS already....

[locolorenzo22, BSN, RN]

sepsis, or a brain injury(new) that could cause it....how long are we talking here for being unable to get a temp?

[JessicRN]

Some other possibilities can be that it was drug related.

These need to be ruled out as well. A common cause of hypothermia is taking of multiple drugs that affect the sympathetic and parasympathetic system, as well as anti-depressants and drugs that affect serotonin and dopamine levels in the brain.

Several drugs used to treat spinal cord injuries can aggravate hypothermia. Ditropan,lithium, gabapentin,tylenol in high doses,topamax,valium, to name a few.

Other things to rule out: diabetes, malnutrition, and thyroid disease may contribute to hypothermia. People with poor blood flow (due to arteriosclerosis) are more susceptible to hypothermia. These need to be ruled out as well