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Inpatient Hypothermia?

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Was going to post this in the Critical Care subforum but I'm curious for others' thoughts as well. I've been off for a couple weeks, came back and got called re: a temperature of 28C on one of our patients.  (Details changed enough to prevent identification)

40yo caucasian male w/ hx tetraplegia 2/2 epidural abscesses d/t bacteremia 10/2020.  Vent dependent trach was d/c'd to an LTACH, came back after a PEA arrest, recurrent MSSA bacteremia. Currently stone cold stable on cefazolin, intermittent HD, no pressors.  Temp earlier was 36C, RN called to say multiple temporal and oral readings were 28, I blew it off as the guy (quasi neuro intact) is nodding yes/no to Q's, feels cool but not like COLD to touch seemed fine.  Replaced foley w/ a temp sensing and I'll be damned if his temp isn't 28.4C.  No beta blockers, only neuroleptic is gabapentin @ 100tid. 

Anyone work rehab or with spinal patients know if this type of temperature dysregulation is seen with SCI? I mean I've read case reports of around 32-33C but 28 is pretty concerning.  TSH and cortisol are pending.

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On 4/14/2021 at 12:53 AM, EMEDPA said:

This was my thought as well. 

Also hypothalamic insult of some kind(trauma, tumor/bleed)? 

Weird case. Let us know the outcome please. 

Well. TSH and cortisol were normal as was the CTH. His BP has now started intermittently tanking so I'm chalking it up to an autonomic dysregulatory issue. To be 100% honest I absolutely hate neuro.

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