(1611) Fever Conundrum: Zorses Versus Hebras: Dexmedetomidine a Vital Consideration

Introduction: Sedation in the Intensive Care Unit (ICU) is critical for patient management, with Dexmedetomidine (Precedex) being a preferred choice due to its effective sedation and analgesia properties. Precedex allows patients to remain easily arousable and reduces the need for additional sedation and the risk of delirium. It also shortens the time to extubation and reduces ventilator dependence compared to midazolam and propofol. Despite these advantages, Precedex can cause adverse effects such as hypotension, bradycardia, vomiting, and fever, which are sometimes overlooked.

Description: We present a case of a 61-year-old male admitted to the ICU with septic shock and respiratory failure after sigmoid colon resection complicated by fecal peritonitis, intrabdominal abscess, and wound dehiscence. The patient experienced persistent high-grade fevers up to 104°F while on Continuous Renal Replacement Therapy (CRRT) and appropriate treatment of sepsis. Despite resuscitation, antibiotics, antifungals, and several surgeries to identify the source of infection, no additional infection or other source of infection was found. Repeated cultures remained negative as well. Concerns about malignant hyperthermia from anesthesia led to the administration of Dantrolene, which was ineffective. Adjustments such as changing CRRT temperature and using cooling blankets also failed to reduce the fever. The breakthrough came when Precedex was identified as the likely cause of the persistent fever. Once Precedex was discontinued, the patient's fever decreased from 102°F to 98°F within two and a half hours.

Discussion: The usage of Precedex in ICU is becoming more prevalent and is being increasingly prioritized as sedation. This case underscores the rarity yet significance of Precedex-induced fever, which affects 5-7% of patients. Despite numerous potential causes, we identified Precedex as the source of persistent pyrexia after other diagnoses were excluded. This highlights the need for early recognition of medication-induced fever, as continued use of Precedex led to unnecessary treatments and invasive procedures. Awareness of this rare but important side effect with a high index of suspicion is crucial, especially in ICU settings with persistent, unexplained fevers.