RISPERIDONE-INDUCED MODERATE CENTRAL HYPOTHERMIA

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Risperidone is a second-generation atypical antipsychotic medication (APD) commonly used to treat schizophrenia and bipolar disorder. An infrequent dangerous side effect of APDs hypothermia, defined as core body temperature < 35 Celsius (C) [1]. CASE PRESENTATION: A 61-year-old male with hypertension, epilepsy, was transferred the emergency department for bilateral lower extremity weakness slow speech two days. Medications included carbamazepine risperidone. He denied being outside in cold stated he has heater at home. week prior, follow-up his primary physician, oral 35.5C. clinical exam revealed dysphasia right leg weakness. Core rectal 29.1C, indicating moderate hypothermia. Computed tomography head neck contrast displayed no acute intracranial abnormality. Blood work normal thyroid-stimulating hormone, cardiac enzymes, lactic acid. Urinalysis negative infection. Chest x-ray showed abnormalities. Carbamazepine level therapeutic range. In intensive care unit, given warmed intravenous fluids placed on an external warmer constant monitoring. Due central hypothermia concerns, risperidone held, warming applied. Gradually, increased 36.5C over next 14 hours. had signs infection or metabolic derangements increase risk. improved quickly downgraded medical floor. DISCUSSION: Experimental animal model studies reveal dose-dependent decline [2]. The exact incidence higher than reported literature based reports submitted Food Drug Administration. Mild common rare after few years therapy [3]. symptoms are inconspicuous odd, like apathy, confusion, shivering, hunger, often missed Clinical thermometers fail register 34.4C. risk more men patients Risk factors such age > 70 years, other APDs, organic diseases amplify it highly antagonistic serotonin receptors (5-HT2a) dopamine (D2) a2 adrenergic receptors. 5-HT2a act while D2 acts decrease APD use leads imbalance promoting temperature. Monitoring essential initiation dosage changes. Consideration comorbidities must. CONCLUSIONS: induced rare, reversible cause. Failure recognize by critical providers can be fatal. REFERENCE #1: Polderman KH. Mechanisms action, physiological effects, complications Crit Med. 2009;37(7 Suppl):S186-202 #2: Oerther S, Ahlenius S. Atypical antipsychotics D(1) receptor agonism: vivo experimental study using measurements rat. J Pharmacol Exp Ther. 2000;292(2):731-736. #3: : Szota AM, Araszkiewicz AS. factors, frequency diagnosis drug-induced hypothermia: practical advice doctors. Int Clin Psychopharmacol. 2019;34(1):1-8. DISCLOSURES: No relevant relationships Dennis Chairman, source=Web Response Sahithi Katragadda, Parth Patel, Tarang SACHIN PATIL,