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Hyperthermia in a Patient on Polypharmacy
Case Study
A rapid response event was initiated by the bedside nurse for a patient who developed severe hyperthermia. Upon the arrival of the rapid response team (RRT), the patient was noted to be a 45-year-old male admitted to the hospital for severe depression. The bedside nurse informed the RRT that his temperature had been normal on morning vital signs. The patient had reported a racing heart to the nurse, who checked his vitals and found him to have elevated temperature. A review of his chart showed that he was taking sertraline for depressive disorder. Buspirone had been added to the patient’s regimen that morning. He had also received his usual dose of trazodone the evening before, which he was taking for insomnia. The patient denied taking any illicit substances. He was not on any other prescription or over-the-counter medications or supplements.
Vital Signs
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Temperature: 105 °F, axillary
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Blood Pressure: 180/90 mmHg
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Heart Rate: 102 beats per min (bpm), sinus tachycardia on the monitor
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Respiratory Rate: 22 breaths per min
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Pulse Oximetry: 98% saturation on room air
Focused Physical Examination
A quick exam revealed a middle-aged male, awake and alert, and answering questions. His face was flushed, and there was visible perspiration on his forehead. He appeared agitated. Visual tracking was intact without evidence of nystagmus. His cranial nerve exam was unremarkable. There was evidence of rigidity with passive movement of his extremities, and his patellar reflexes were noted to be 3+ bilaterally. A cardiac exam revealed tachycardia without evidence of murmurs. His lung exam was unremarkable, and his abdominal examination revealed hyperactive bowel sounds.
Interventions
A cardiac monitor and pacer pads were attached to the patient immediately. Blood sample for stat laboratory tests was drawn, which included a complete blood count (CBC), comprehensive metabolic panel (CMP), creatine phosphokinase (CPK), lactate level, and blood cultures. A urine drug screen was also ordered. Then, 1 g of intravenous acetaminophen was administered immediately, which had no effect on the patient’s temperature. Ice packs were placed along his neck, axilla, and groin. The patient’s labs were later reported and showed elevated CPK level, elevated lactate level, and mild acute renal insufficiency. With relevant history and laboratory examination, a presumptive diagnosis of serotonin syndrome was made. Intravenous fluids were started, and the patient was immediately given 2 mg of IV lorazepam to induce mild sedation and decrease muscle activity. The orders for the patient’s sertraline, buspirone, and trazodone were discontinued, and a consult was placed for psychiatry to evaluate the patient’s medication regimen. The patient was transferred to the intensive care unit (ICU) for further management and possible need of further sedation, neuromuscular blockage, and mechanical ventilation.
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