Abstract
Severe accidental hypothermia has been demonstrated to affect ventricular systolic and diastolic functions, and rewarming might be responsible of cardiovascular collapse. Until now, there have been only a few reports on severe accidental hypothermia, none of which involved children. Herein, we describe here a rare case of heart failure in a 6-year-old boy admitted to the emergency unit owing to severe hypothermia and malnutrition. After he was warmed up (core temperature of 27.2°C at admission), he developed cardiac arrest, requiring vasoactive amines administration, and veno-arterial extracorporeal membrane oxygenation. Malnutrition and refeeding syndrome might have caused the thiamine deficiency, commonly known as beriberi, which contributed to heart failure as well. He showed remarkable improvement in heart failure symptoms after thiamine supplementation. High-dose supplementation per os (500 mg/day) after reconstitution of an adequate electrolyte balance enabled the patient to recover completely within 2 weeks, even if a mild diastolic cardiac dysfunction persisted longer. In conclusion, we describe an original pediatric case of heart failure due to overlap of severe accidental hypothermia with rewarming, malnutrition, and refeeding syndrome with thiamine deficiency, which are rare independent causes of cardiac dysfunction. The possibility of beriberi as a cause of heart failure and adequate thiamine supplementation should be considered in all high-risk patients, especially those with malnutrition. Refeeding syndrome requires careful management, including gradual electrolyte imbalance correction and administration of a thiamine loading dose to prevent or correct refeeding-induced thiamine deficiency.
Highlights
The effects of severe hypothermia and rewarming on human cardiac function have not yet been well established, especially in children
We report a case of a 6-year-old boy admitted to the emergency unit owing to severe hypothermia and unconsciousness
We described the first case of suspected beri-beri and hypothermia-induced heart failure in a child
Summary
The effects of severe hypothermia and rewarming on human cardiac function have not yet been well established, especially in children. Echocardiography showed a structurally normal heart with a biventricular global dysfunction [left ventricular ejection fraction (LVEF) of 30%, with mitral insufficiency of grade 2/4 and protodiastolic and end-diastolic pressures, measured on pulmonary insufficiency, at 22 and 15 mmHg, respectively]. Despite the use of amines, degradation of mainly the left heart function occurred within a few hours (H20), requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Echocardiography at week 3 showed a diastolic dysfunction (proto-diastolic pressure estimated at 25 mmHg, moderate dilatation of the inferior vena cava) despite a normal systolic function with LVEF of 64%. Despite a complete recovery of the systolic heart function, a mild diastolic dysfunction persisted. One month later both systolic and diastolic functions normalized (Figure 1). The patient’s condition continued to improve and 1 month later, the patient’s clinical and biochemical parameters were completely restored
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