title: Managing combined critical hypothermia, diabetic ketoacidosis and cocaine intoxication noninvasively.
abstract: Severe hypothermia with a core temperature below 28°C is critical especially in patients with diabetic ketoacidosis (DKA) and carries a high risk of mortality. Our case of a 52-year-old woman presenting with DKA, pH of 6.9, potassium of 7.6 mEq/L, and body temperature of 26°C demonstrates that conservative management can be safe and successful. We used an established cardiac arrest rewarming phase protocol modified to active warming with the Meditherm 3 Machine and the facility-used rigorous DKA protocol to successfully and safely achieve rewarming without hemodialysis or extracorporeal maneuvers. Our patient arrived even more hypothermic than all previously described cases and regained normothermia and an equalized acid-base and electrolyte balance within 12 hours after admission. Eventually, no new neurologic deficit was present on discharge.
authors.affiliation: Department of Medicine, Rochester General Hospital, Rochester, NY, USA. Electronic address: miriamfreundt@me.com.
authors.forename: Miriam
authors.initials: M
authors.lastname: Freundt
authors.affiliation: Department of Medicine, Rochester General Hospital, Rochester, NY, USA.
authors.forename: Adel
authors.initials: A
authors.lastname: Obaji
authors.affiliation: Department of Medicine, Rochester General Hospital, Rochester, NY, USA; Nephrology Division, Rochester General Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY 14621USA.
authors.forename: John K
authors.initials: JK
authors.lastname: Hix
mesh_terms: D003042:Cocaine / Q000506:poisoning*; D016883:Diabetic Ketoacidosis / Q000150:complications*; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000209:etiology* / Q000628:therapy*; D008875:Middle Aged
chemical_list: D003042:Cocaine