Management of Gabapentin-Induced Hypothermia
Immediately discontinue gabapentin and initiate active rewarming measures based on the severity of hypothermia, as drug-induced hypothermia requires prompt removal of the offending agent combined with temperature-directed supportive care.
Immediate Actions
Discontinue the Offending Agent
- Stop gabapentin immediately upon suspicion of drug-induced hypothermia, as this is the primary intervention for all drug-induced temperature dysregulation syndromes 1, 2
- Drug-induced hypothermia can be life-threatening and requires prompt recognition and discontinuation of the causative medication 2
Assess Severity and Initiate Rewarming
Mild Hypothermia (32-35°C):
- Remove wet clothing immediately and move patient to warm environment 3, 4
- Apply warm blankets and increase environmental temperature 3, 4
- Provide high-calorie foods or warm drinks if patient is alert 3
- Allow passive rewarming with insulation 4
Moderate Hypothermia (28-32°C):
- Continue all mild hypothermia interventions 3
- Implement active external rewarming: heating pads, forced warm air blankets (Bair Hugger), or chemical heat blankets 3, 4, 2
- Administer warmed intravenous fluids 3, 4
- Provide humidified, warmed oxygen 3
Severe Hypothermia (<28°C):
- Continue all moderate hypothermia measures 3
- Activate emergency response system 3
- Consider active core rewarming methods including peritoneal lavage with warmed fluids 4
- Handle patient gently to avoid triggering cardiac arrhythmias 3
Monitoring and Supportive Care
Temperature Monitoring
- Assess core temperature every 5-15 minutes depending on severity 3
- Target minimum core temperature of 36°C before considering transfer 3, 4
- Cease rewarming after reaching 37°C, as higher temperatures are associated with poor outcomes 3, 4
Complications to Monitor
- Cardiac arrhythmias during rewarming 3
- Rewarming shock 3
- Coagulopathy 3
- Burns from improper use of active external rewarming devices 3
- Hypotension and bradycardia (commonly seen with drug-induced hypothermia) 2
Additional Workup
Rule Out Alternative Causes
- Obtain blood cultures and infection workup with procalcitonin 2
- Check cortisol levels and thyroid function to exclude endocrinopathy 3, 2
- Review medication history for other potential causative agents 1
Clinical Pearls
Key Pitfall: Hypothermia is often overlooked during initial resuscitation; emphasis should be on prevention first and treatment second 4. In the case of drug-induced hypothermia, the temporal relationship between medication initiation and symptom onset is critical for diagnosis 1, 2.
Rewarming Rates: Shivering can increase rewarming rates up to 3.6°C/hour, and external rewarming with forced-air warmers can be effective even in severe cases with temperatures below 30°C 4.
Prognosis: Once gabapentin is discontinued, normothermia should be achieved and maintained without continued aggressive rewarming measures, as demonstrated in case reports where temperature stabilized after drug discontinuation 2.