Resident Bassett Medical Center Cooperstown, New York, United States
Introduction: Dexmedetomidine, an alpha agonist, is one of the best choices for sedation in the intensive care unit (ICU). The drug allows patients to be comfortable and cooperative with a limited number of adverse effects, of which the most common are hypotension and bradycardia. In this case - fever, an underrecognized adverse effect, presented differently than previously described in the literature.
Description: A 44-year-old man with a history of facioscapulohumeral muscular dystrophy presented after a Motor Vehicle Accident. The Trauma team was activated, and the patient underwent a workup which was remarkable for pulmonary contusion, multiple thoracic cage and vertebral fractures, displaced left distal femur and tibial plateau fractures. During orthopedic surgery he developed significant blood loss and respiratory failure, he remained dependent on a ventilator afterward and was admitted to ICU. On day 2 of his stay, he was started on Dexmedetomidine at a dose titrated from 0.3 to 1.2 mcg/kg/hr with a goal of RASS -2. After 32 hours he spiked fever up to 39.3. He was pancultured and started on antibiotics with a broadened regime later. Subsequently, he underwent extensive workup without revealing underlying pathology, - fever sustained. Dexmedetomidine, as a suspected agent, was stopped on day 5 with defervescence in 12 hours. Later, Dexmedetomidine was re-trialed on day 13 for appropriate sedation as the root cause of fever was still unclear. The patient spiked fever 31 hours later up to 39.8, repeatedly underwent comprehensive workup, and was started on empiric antibiotics with the involvement of multidisciplinary consultations. Eventually, Dexmedetomidine was discontinued on day 18 as a suspected cause and the fever resolved 7 hours later.
Discussion: Dexmedetomidine-induced fever remains poorly recognized and challenging to establish in complex ICU environments. The data shows that fever occurs in about 5% of patients, and ceases in 3 to 4 hours after drug discontinuation. In our case, the defervescence took longer than reported likely due to the patient’s complicated condition. The case is to highlight the side effect and the extended time for the fever to subside. Although a diagnosis of exclusion, timely recognition of drug-induced fever may avoid more invasive or extensive interventions.
