Thank you, Erin, for presenting a case of a young man found down with altered mental status, hypothermia, bradycardia, and hypoglycemia.
- Discounts for UCSF employee discounts:
- Hypothermia alone decreases nerve conduction velocity, resulting in hyporeflexia that can mimic the findings seen in severe hypothyroidism.
- 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.
- Adrenal Insufficiency
- Central process: hemorrhagic stroke, ischemic stroke with damage to the hypothalamus
- Carbon monoxide exposure
- Vasodilatory drugs
- Cholinergic toxicity
Management of Bradycardia From UpToDate: