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A 7 year old girl was admitted with right lower lobe pneumonia. On admission her temperature was 39.7°C. After five hours she received ibuprofen (6 mg/kg). Susequent to this single dose her temperature decreased to 33.5°C (core temperature 34.9°C) over four hours.
On examination her pulse was 90/min, blood pressure 90/50 mm Hg, SaO2 96% in air, and respiratory rate 20/min. Respiratory examination was consistent with signs of right lower lobe consolidation. The rest of the examination, including the central nervous system, was unremarkable.
Results of investigations included: Hb 125 g/l; white blood cell count 10.7 × 109/l platelet count 81 × 109/l; C reactive protein 180 mg/l; blood glucose 4.6 mmol/l. Electrolytes and all other biochemical investigations were normal. Thyroid and cortisol assays were normal. Results of all tests to determine possible bacterial or viral aetiology were all negative (blood and urine culture, viral serology, and tests for mycoplasma). Magnetic resonance imaging (MRI) of the brain was normal.
The hypothermia was so marked that we had to use a hot air spacer blanket to raise her temperature. Despite all the efforts she remained persistently hypothermic for four days (see fig 1⇓).
A single dose of hydrocortisone and an albumin infusion were given initially. She was subsequently treated with warmed intravenous fluids for three days and antibiotics for 10 days. She recovered completely and continues to enjoy good health.
Profound hypothermia is extremely rare in children over 5 years of age. Results of investigations excluded infective and endocrine causes. A normal MRI brain scan showed there was no lesion of the hypothalamus or corpus callosum.
Ibruprofen is commonly prescribed for a raised temperature and is well tolerated in children. Side effects are not common, even in overdose.1 Nevertheless we postulate that ibuprofen was responsible for hypothermia in this case. We are not aware of any published evidence documenting hypothermia after a single therapeutic dose of ibuprofen, but it has been recorded in a few cases of accidental and deliberate overdosage. Although patients may sometimes receive ibuprofen in toxic quantities, hypothermia is not a consistent feature.2,3 Hypothermia in overdosage is attributed to central nervous system depression.4