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An 89-year-old woman was brought to the emergency department, responding only to pain (GCS 6), with a rectal temperature of 28.5°C, hypotension (68/40), bradycardia (35/min) and bradypnoea. The remainder of the examination was unremarkable.
She was living at home with her son and a caretaker, confined to bed/wheelchair with a history of Alzheimer’s dementia, falls, hypothyroidism (on replacement), hypertension and chronic atrial fibrillation (AF) (on amlodipine 5 mg four times a day, propranolol 10 mg three times a day). Other regular medications included quetiapine (Seroquel) 125 mg four times a day and brotizolam 0.25 mg.
Laboratory tests showed no evidence of infection or metabolic disorder except acidosis (pH 7.27). Thyoid stimulating hormone (TSH) and cortisol levels were normal. Chest X-ray, head CT and urinalysis were unremarkable; ECG showed slow AF. …
Contributors AS wrote the manuscript with the participation of ID. ID and AS planned the study. AS conducted a survey of the literature and composed the manuscript, aided by ID.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Next of kin consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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