Osborn waves in the electrocardiogram, hypothermia not due to exposure, and death due to diabetic ketoacidosis

Abstract

Summary:Hypothermia usually occurs because a patient has been exposed to a cold environment; however, a number of nonenvironmental conditions may produce hypothermia. This report relates the clinical course of a patient whose hypothermia was due to severe diabetic ketoacidosis. In addition, we review the causes of hypothermia and Osborn waves beyond exposure to cold temperature. Hypothermia due to diabetic ketoacidosis is an uncommon complication of a common disease that carries with it clinically significant consequences. Accordingly, we believe that all clinicians should be aware of this potential complication of diabetic ketoacidosis and should be able to recognize the importance of the electrocardiogram in such patients.

Estudo da hipotermia acidental em idosos institucionalizados

“…9,21,23 Our sample included four episodes of recent falls (approximately 10 percent of cases), but they were unrelated to the hypothermia.…”

“…It is general knowledge that drug interactions and abuse of certain psychotropic agents can further increase the risk of onset of hypothermia. 23 In addition, several classes of medications prescribed to elderly patients may induce hypothermia by heat loss, such as antipsychotics and antihypertensive alpha-blockers. [23][24][25][26] The high number and category of comorbidities, both clinic (hypertension in 91.4 percent of cases) and psychiatric (dementia syndrome in 71.4 percent of cases reported here) in our group imply constant use of medications, especially antihypertensives and various psychotropic antidepressants and/ or antipsychotics, prescribed for 37.1 percent of the cases in this study.…”

“…23 In addition, several classes of medications prescribed to elderly patients may induce hypothermia by heat loss, such as antipsychotics and antihypertensive alpha-blockers. [23][24][25][26] The high number and category of comorbidities, both clinic (hypertension in 91.4 percent of cases) and psychiatric (dementia syndrome in 71.4 percent of cases reported here) in our group imply constant use of medications, especially antihypertensives and various psychotropic antidepressants and/ or antipsychotics, prescribed for 37.1 percent of the cases in this study. To establish that polypharmacy did indeed represent a predisposing factor of hypothermia in this sample, we should have better assessed the quantity and quality of pharmaceuticals prescribed and administered to patients with hypothermia, compared to those who did not suffer hypothermia during the same period.…”

Diabetic Ketoacidosis

“…The mechanism of hypothermia complicated by DKA is unclear, but the inability of glucose to endocytose due to insulin deficit which leads to a lack of substrate for cellular heat production has been proposed [84]. A characteristic elevated J point on the electrocardiogram (ECG) (Osborn wave) may be observed when markedly hypothermia occurs [85][86][87]. The thermoregulatory system could be impaired in diabetic patients with autonomic neuropathy and reduced muscle mass or adipose tissue related with malnutrition.…”

Osborn waves in sepsis-induced hypothermia

“…Non environmental causes of hypothermia, include hypothyroidism, hypopituitarism, diabetic ketoacidosis, cerebrovascular accidents, sepsis, antipsychotic medication and prolonged cardiac arrest [1].…”