60+ yr old female patient admitted for hyperkalemia/ARF/UTI 6 days ago is stable on my floor. Multiple co-morbidities including DM, hypothyroid, past ARF, CHF, CVA x 2, COPD, RA and a new 2 cm mass in her lungs found this admission. Pt is 60 but looks 80. Multiple immune disorder markers are found in her blood (all of those funky labs I can't remember right now) and they are hoping to treat the auto-immune disorder to help the kidneys rather than resort to dialysis.
Ok. Patient's baseline is AAOX3 with poor short term memory. She is on O2 2L NC with sats 95-97. BP and HR stable. Afebrile. Poor appetite and frequent c/o nausea. Slightly elevated WBCs and elevated but stable BUN/Cr (sorry, don't remember exact numbers). Overall, her daily CBC and BMP looked ok for her.
Around 11, patient changed - she became more lethargic and slight slurring of speech. She kept saying "I feel so. . strange". BS 118, vitals WNL, did full assessment and mentioned it to the MD who was on the floor who saw her but he dismissed it saying she was probably just tired. Also, I noticed her legs were edematous so I told the nephrologist (who happened to be standing right there, too) and he ordered some Lasix.
She slept for a couple of hours and when she woke up she looked. . .sick. Vitals still fine except. . .I can't get a temperature. I try two thermometers. I try oral and axillary. Won't read. So, I get a rectal and her temp is 93.8. I'm like !?!?!??!?!?!?!??!!?
Get the MD back in the room (that got his attention) and a bunch of orders (blood cultures, urine culture, chest xray, ABGs) When I ask MD why the low temp, he shrugs. I ask if it could be sepsis, he really doesn't know.
At this point, I called a rapid response (because patient was looking really crappy) so they came and took over and I didn't get to see all of the ABG results, but I did see she had critical acidosis and low Pa02 (couldn't see numbers or anything else)
So, they want to put her on a thermal bipap thing (which I didn't know exists) so off she goes to ICU.
And here I sit trying to make sense of it all. What would make her temperature go so low?
I'm sorry I don't have better data - it was a long day and I don't remember all of the details.
Thank you - interested in your feedback. I've never had a patient with a low temperature before so I am curious about it. I've been doing some research on-line and I seem to be going in circles with it all.
