BMJ Case Reports 2017; doi:10.1136/bcr-2017-222462
  • Unexpected outcome (positive or negative) including adverse drug reactions

Severe recurrent hypothermia in an elderly patient with refractory mania associated with atypical antipsychotic, valproic acid and oxcarbazepine therapy

Open Access
  1. Suzanne Holroyd
  1. Department of Psychiatry & Behavioral Medicine, Joan C. Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
  1. Correspondence to Dr Suzanne Holroyd, holroyds{at}
  • Accepted 30 October 2017
  • Published 2 December 2017


Hypothermia is a rare but serious condition that has been associated with various psychiatric medications. We present a 76-year-old woman with refractory mania who developed multiple episodes of severe hypothermia associated with several psychiatric medications including olanzapine, quetiapine, valproic acid and oxcarbazepine. These episodes resolved following discontinuation of the agents. The patient had never experienced hypothermia before, despite having been on these or similar agents for many years. With traditional treatments for mania not feasible, other medications were used to treat her including lithium, clonazepam, gabapentin and the novel protein kinase c inhibitor tamoxifen. The regimen resulted in some success and importantly, without triggering hypothermia. This case alerts clinicians to the rare side effect of hypothermia in response to various psychiatric medications, the fact that patients can suddenly develop this intolerance and suggests possible medications that may be used safely without triggering hypothermia.


  • Contributors OOA: primary author, responsible for acquisition and review of patient paper records to obtain essential data on hypothermic events and medications, responsible for literature review, drafting and revising the work for important intellectual content and provides approval for publication of content. SH: responsible for conception and design of case, made substantial/extensive contributions to drafting and revising work for important intellectual content and provides approval for publication of content.

  • Competing interests None declared.

  • Patient consent Guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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