Disclosures: Ellen M. Farr, MD: No financial relationships or conflicts of interest

Case Description: She was admitted after surgical repair of multiple bleeding cavernomas with new hypothalamic dysfunction. No issues were noted upon admission with her vital signs, but during her first week axillary temperatures were intermittently 96oF and heartrates transiently dropped to the 40s. One evening her temperature was noted to be 92.2 oF and could not be successfully re-warmed. She became bradycardic, hypotensive, and altered necessitating transfer. At the acute care hospital, her temperature nadired at 88 oF with bradycardia of 38, and hypotension of 65/35. She required atropine twice, was admitted to the ICU, and required warming blankets and warmed IV fluids to stabilize temperatures. With rewarming, her other vital signs improved, and her mental status normalized. Extensive workup showed no etiology and it was thought the autonomic dysfunction was her new baseline.

Setting: Pediatric Inpatient Rehabilitation Facility

Patient: 18-year-old female with history of congenital cavernous malformations complicated by hemorrhages resulting in hypothalamic injury. Assessment/

Results: She returned to inpatient rehabilitation with vital signs somewhat stabilized. Hypothermia continued to occur nightly and was treated by a Bair hugger. The episodes resolved within 1 hour. Bradycardia and hypotension were treated with BID caffeine pills. With these simple interventions, she was able to continue to participate in therapies and avoided further transfers to the acute care hospital.

Discussion: Autonomic dysfunction can occur with hypothalamic injury. Cases of hypothermia related to hypothalamic injury have been treated with medications (ie. clonidine or cyproheptadine). In this case typical medications were not options given the co-existing bradycardia and hypotension. This case shows how autonomic dysfunction can be safely treated in the pediatric population using a Bair hugger and caffeine pills in lieu of more potent systemic medications with greater side effect profiles.

Conclusion: In specific cases, a Bair hugger and caffeine pills can help prevent re-hospitalization and provide simplified treatment of autonomic dysfunction.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/unbairable-cold-a-case-of-hypothermia-treated-with-a-bair-hugger/