However, a week after admission, she became markedly drowsy again without any sedatives such as benzodiazepines. She was found to be mildly dehydrated

though she was hemodynamically stable and the rest of the physical examination was normal. She was afebrile and her capillary blood sugar level was normal. She was urgently transferred to the medical unit for further assessment and medical care. Her full blood count, renal function tests, liver function tests and creatine phosphokinase levels were within normal limits and erythrocyte sedimentation rate was marginally elevated. However, her electrocardiogram showed a ‘J’ wave Inhibitors,research,lifescience,medical (Figure 1) suggestive of hypothermia and a heart Inhibitors,research,lifescience,medical rate of 65 beats per minute, which was normal. Her body temperature was measured as 92°F (33.3°C) which indicated she was suffering from hypothermia. Her body temperature was closely monitored and she was warmed with blankets and application of external heat with hot-water bottles. The treating consultant physician suspected that the hypothermia was induced by antipsychotics and hence withheld risperidone while continuing sodium valproate and continued supportive care and close monitoring. In addition she was prescribed intravenous Selleckchem GDC0449 antibiotics since she had clinical and radiological evidence of lower respiratory Inhibitors,research,lifescience,medical tract infection such as

productive cough and bilateral multiple opacities in Inhibitors,research,lifescience,medical the chest X-ray. Her hypothermia settled within a week as the temperature picked up to 98.5°F, thus the treating physician ascertained that the patient suffered from risperidone-induced hypothermia. The repeat ECG revealed the disappearance of J waves (Figure 2). Figure 1. Electrocardiogram (ECG) obtained at the time of hypothermia showing J waves. Figure 2.

Inhibitors,research,lifescience,medical The repeat electrocardiogram (ECG) taken after the return of normothermia showing the disappearance of J waves. Since her manic symptoms persisted, haloperidol 3 mg twice daily was added to her medication regime and her manic symptoms subsided with time. She was psycho-educated about the illness and the use and side effects of the medications, especially why regarding hypothermia and the measures to be taken at home with regards to this. Nearly a month after admission, she was discharged from the ward and has been followed up in the outpatient clinic to date. She had been compliant to the medication regime and was functioning well. She tolerated the medications fairly well and had not had any hypothermic episodes so far. Discussion This case is unique as it reports a rare but potentially serious side effect occurring after a prolonged administration (nearly 3 and 1/2 years) of the offending drug contrary to the previous reports in which hypothermia occurred only a few hours or days after the administration of the index medication.