Postgraduate medical journal
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Review Case Reports
Multi-system complications of hypothermia: a case of recurrent episodic hypothermia with a review of the pathophysiology of hypothermia.
A 61-year-old woman with secondary progressive multiple sclerosis presented on six occasions over a 2-year period with severe hypothermia (31-33.5 degrees C). This resulted in numerous multi-system complications comprising acute pancreatitis, hepatitis, gastrointestinal haemorrhage, psychiatric disturbance, bradycardia, paradoxical sweating, thrombocytopenia, anaemia and raised inflammatory markers. Septic screens were consistently normal. ⋯ The case report is followed by a review of dysfunctional thermoregulation and pathophysiology of hypothermia-induced multi-system complications. A key learning point is to recognise that the clinical manifestations of hypothermia may be widespread and serious but are nonetheless reversible. In addition, one should consider the differential diagnosis of covert hypothermia in those patients with episodic confusion, as hypothermia is under-recognised, particularly in older people, who are prone to accidental hypothermia, and in those with common neurological conditions, such as stroke, head injury and multiple sclerosis, that may have suboptimal thermoregulation.
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Rhabdomyolysis is a rare but life-threatening complication of statin therapy. A 74-year-old man, treated with atorvastatin, developed rhabdomyolysis after the co-administration of fusidic acid and flucloxacillin. The patient recovered with supportive treatment and subsequently tolerated reintroduction of atorvastatin. Pharmacokinetic interactions can cause raised plasma statin concentrations, which can precipitate rhabdomyolysis in the presence of certain predisposing biological factors.