Intern Report Pearls 12/20/17 – hypothermia and bradycardia

Thank you, Erin, for presenting a case of a young man found down with altered mental status, hypothermia, bradycardia, and hypoglycemia.

Key Pearls:

  1. Discounts for UCSF employee discounts:

http://ucop.edu/localhumanresources/oplife/employeediscounts/

  1. Hypothermia alone decreases nerve conduction velocity, resulting in hyporeflexia that can mimic the findings seen in severe hypothyroidism.
  2. Glucagon is an agonist at glucagon-specific G-protein coupled receptors, resulting in activation of adenylyl cylcase and increasing cAMP. In this way, glucagon can bypass the beta-adrenergic receptor sites that are blocked by beta-blockers and increase the HR and cardiac contractility.
  • Here is a report of the use of glucagon for beta-blocker overdose. Unfortunately, there are little to no randomized controlled data to support the benefits of glucagon for beta blocker overdose.
  • And here is a 2015 post by Carly Zapata from the blog about how glucagon works and some safety precautions to keep in mind when you’re thinking about using it.

DDx for Hypothermia

  • Exposure! – generally the most common explanation, but think of as a diagnosis of exclusion.
  • Infection! – probably the second most common! Most hypothermic patients should get empiric coverage for sepsis.
  • Endocrinopathies:
    • Hypothyroidism
    • Adrenal Insufficiency
    • Hypotiuitarism
    • Insulinoma
  • Central process: hemorrhagic stroke, ischemic stroke with damage to the hypothalamus
  • Ingestions/Toxins:
    • Carbon monoxide exposure
    • Alcohol
    • Vasodilatory drugs
    • Benzos
    • Cholinergic toxicity

Management of Bradycardia From UpToDate:

Capture

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