1235

Abstract

Introduction: Hypothermia is a known side effect of atypical antipsychotic drugs which generally resolves following discontinuation of the offending agent. We report a case of refractory hypothermia leading to death in a patient taking risperidone for treatment of schizophrenia. A 67-year-old man presented to our ED with hypothermia and delirium after being found stuperous at a nursing facility. He had been at baseline until 14 days prior to presentation when temperature was noted to be 88°F. Hypothermia persisted despite discontinuation of risperidone and initiation of olanzapine. Past medical history included schizophrenia, HIV (CD4: 398), and gout. There was no history of thyroid disease or ambient exposure. Vital signs were temperature 86.4°F, pulse 69, and respiratory rate 37. He was minimally responsive to painful stimuli. Neurologic exam was non-focal. Pertinent work-up showed: creatinine 2.6, TSH 5.7, cortisol 28, and pancytopenia. CXR showed pleural effusions. EKG was negative for Osborn waves. Head CT, CSF, BAL, blood, and urine cultures were all negative. Hypothermia persisted despite use of external warming device and discontinuation of olanzapine. On hospital day 2, he became hypotensive and was transferred to the ICU where antibiotics and vasopressors were initiated. On hospital day 7, he had two PEA arrests and care was withdrawn. Severe hypothermia, although a rare and usually benign side effect of antipsychotics, is the most likely diagnosis in this case given that ambient exposure, long-standing thyroid disease, adrenal insufficiency, and sepsis were all ruled out as inciting factors. To our knowledge, there have been 129 reported cases of risperidone-induced hypothermia. This case stands out because of the poor outcome. Risperidone is renally cleared and our patient's impaired kidney function likely increased his risk for side effects. Prescribers should be aware of the adverse effects of risperidone and discontinue antipsychotics at onset of hypothermia.