Antipsychotica als oorzaak van diepe hypothermie

Two patients were presented at our hospital with hypothermia following dose adjustment of antipsychotic medication. The first patient, a mentally retarded 45-year-old man developed a temperature of 31.7°C several days after starting of levomepromazine. The second patient, an 41-year-old schizophrenic man, whose risperidone dose had been increased following a psychotic crisis, developed deep hypothermia (temperature 29.7°C) and severe respiratory insufficiency requiring pressure support ventilation. Both patients were admitted to the ICU and recovered completely. Antipsychotics influence hypothalamic thermoregulation and may induce hypothermia by stimulating dopamine (mainly D₂) receptors and blocking 5-HT2 receptors. Furthermore, antipsychotics may reduce the shivering capability and can cause peripheral vasodilatation and reduced shunting by blocking skin α₁ receptors. Hypothermia can be a lethal condition. When a patient's clinical condition deteriorates following the start of antipsychotic medication, the presence of hypothermia should be excluded.