Spontaneus hypothermia - any ideas? 
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 Spontaneus hypothermia - any ideas?

We are treating a patient who has episodes (once every day or so) of
the following symptoms:

- hypothermia
- hyperhidrosis
- hypertonia
- sopor
- tremor, shivering
- mydriasis, slow reaction of the pupillae
- {*filter*} glucose rises to 200-300 mg/dl

The symptoms last about 4 to 10 hours, then the temperature rises
and the other symptoms stop too. The patient is 12 years old, has a
B-NHL, got a bone marrow transplantation 5 weeks ago, developed an
infection (Enterococcus faecium in the faeces) with symptoms of a
sepsis but without any positive {*filter*} cultures. {*filter*} chemistry
indicates that the infection is over but the temperature is between
38,0  and 38,5  C. When developing hypothermia, the temperature falls
about 4   to 34,5  C. EEG shows no seizures, MRI shows slight defects
in the hippocampus and the hypothalamus, so that we have to assume
some kind of central dysregulation. The {*filter*} pressure is resistant
to therapeutic means. There is no evidence for elevated
catecholamines or thyreoid dysfunction. The {*filter*} glucose level does
not respond to insulin, but falls again when temperature rises.

Has anyone seen a similar situation?

Please respond to:



Wed, 28 Apr 1999 03:00:00 GMT
 Spontaneus hypothermia - any ideas?

yes, consider severe hypophosphotemia.
Andrew Chung

Thu, 29 Apr 1999 03:00:00 GMT
 Spontaneus hypothermia - any ideas?

In this clinical setting, I'd still have to focus on a fungemia
or bacteremia rather than a primary hypothalamic problem.
You  might want to re-assess for an abscess.


Thu, 29 Apr 1999 03:00:00 GMT
 [ 3 post ] 

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