The Acute Effect of Chlorpromazine on Body Temperature in Intensive Care Unit Patients

Ömür İlban; Muhammed Emin Zora; Bülent Devrim Akçay; Jale Bengi Çelik; Faruk Çiçekci; Mehmet Ali Baş; Ates Duman

doi:10.54005/geneltip.1116922

Klinik Araştırma

The Acute Effect of Chlorpromazine on Body Temperature in Intensive Care Unit Patients

Yıl 2022, Cilt: 32 Sayı: 6, 658 - 665, 31.12.2022

Ömür İlban Muhammed Emin Zora Bülent Devrim Akçay Jale Bengi Çelik Faruk Çiçekci Mehmet Ali Baş Ates Duman

https://doi.org/10.54005/geneltip.1116922

Öz

Aim: Hypothermia is a rare complication of antipsychotic drugs but serious outcomes including death may result. In this study, we aimed to investigate body temperature alterations in acute phase of chlorpromazine treatment, the relationship of inflammatory indicators and risk factors for hypothermic effect in intensive care unit (ICU) patients.
Materials and methods: 63 intensive care patients who needed sedative treatment due to agitation were divided into two groups as Group 1 (n = 30) with temperatures ≤ 38°C, and Group 2 (n = 33) with temperatures > 38°C according to baseline body temperatures. Also, recurrent measurements for 12 hours were made at specific intervals following 25 mg intravenous chlorpromazine.
Results: In Group 1, decrease in body temperatures was significant from 4th to 12th hours (p < 0.01), while in Group 2, significant decreases in body temperatures at all measurement hours were observed (p < 0.01). Temperature changes (delta temperature) observed at specific measurement intervals were significantly higher in Group 2 compared to Group 1. That difference was statistically significant at all intervals except for ΔTemperature B-6 (p < 0.05). The odds of hypothermic effects by chlorpromazine were 16%, 46%, 3%, and 18% for Acute Physiology and Chronic Health Evaluation II, procalcitonin, C-reactive protein, and white blood cells, respectively.
Conclusion: Chlorpromazine treatment applied for agitation in ICU patients was associated with acute hypothermic effect. Severity of disease and comorbidities might increase risk of hypothermia, and inflammatory biomarkers might be predictors of adverse drug reaction.

Anahtar Kelimeler

adverse drug reaction, body temperature changes, chlorpromazine, intensive care unit, psychomotor agitation

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

The authors would like to thank Prof. Dr. Jale Bengi Çelik and Prof. Dr. Ateş Duman for their contribution to the editing of the article.

Kaynakça

1. Boschi G, Launay N, Rips R. Neuroleptic-induced hypothermia in mice: lack of evidence for a central mechanism. J Pharmac. 1987;90:745–51.
2. Ginawi OT. Possible involvement of opioid receptors in moclobemide-induced hypothermia in mice. Pharmacol Res. 2003;48:237–40.
3. Asanami S, Shimono K. Species-level differences between mice and rats in regards to micronucleus induction with the hypothermia-inducing drug haloperidol. Mutat Res. 2009;676:102-5.
4. Van Marum RJ, Wegewijs MA, Loonen AJ, Beers E. Hypothermia following antipsychotic drug use. Eur J Clin Pharmacol. 2007;63:627-631.
5. Gocke E. Review of the genotoxic properties of chlorpromazine and related phenothiazines. Mutat Res. 1996;366:9-21.
6. Lopez-Munoz F, Alamo C, Cuenca E, et al. History of the discovery and clinical introduction of chlorpromazine. Ann Clin Psychiatry. 2005;17:113-135.
7. Adams F. Neuropsychiatric evaluation and treatment of delirium in the critically ill cancer patient. Cancer Bulletin. 1984;36:156-160.
8. Coppolo DP, May JJ. Self-extubations: A 12 month experience. Chest. 1990;98:165-169.
9. Robinson BR, Mueller EW, Henson K, et al. An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay. J Trauma. 2008;65:517-26.
10. Adams F. Emergency intravenous sedation of the delirious medically ill patient. J Clin Psychiatry. 1988;49:22-26.
11. Marks W. Physical restraints in the practice of medicine: Current concepts. Arch Intern Med. 1992;152:2203-6.
12. Sakkat A, Alquraini M, Aljazeeri J, et al. Temperature control in critically ill patients with fever: A meta-analysis of randomized controlled trials. J Crit Care. 2021;61:89-95.
13. Dippel DW, van Breda EJ, van Gemert HM, et al. Effect of paracetamol (acetaminophen) on body temperature in acute ischemic stroke: a double-blind, randomized phase II clinical trial. Stroke. 2001;32:1607-12.
14. Gramish JA, Kopp BJ, Patanwala AE. Effect of amantadine on agitation in critically ill patients with traumatic brain injury. Clin Neuropharmacol. 2017;40:212-216.
15. Gélinas C. Pain assessment in the critically ill adult: Recent evidence and new trends. Intensive Crit Care Nurs. 2016;34:1-11.
16. Severgnini P, Pelosi P, Contino E, et al. Accuracy of critical care pain observation tool and behavioral pain scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study. J Intensive Care. 2016;4:68.
17. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45.
18. Young DM. Risk factors for hypothermia in psychiatric patients. Ann Clin Psychiatry. 1996;8:93–97.
19. Turkish Society of Anaesthesiology and Reanimation Practice Guideline for Prevention of Unintentional Perioperative Hypothermia. Turk J Anaesth Reanim. 2013;41:188-90.
20. Kreuzer P, Landgrebe M, Wittmann M, et al. Hypothermia associated with antipsychotic drug use: a clinical case series and review of current literature. J Clin Pharmacol. 2012;52:1090-7.
21. Zonnenberg C, Bueno-de-Mesquita JM, Ramlal D, Blom D. Hypothermia due to antipsychotic medication: A Systematic Review. Front Psychiatry. 2017;8:1-9.
22. Kovács E, Jenei Z, Horváth A, et al. Physiologic effects of hypothermia. Orv Hetil. 2011;152:171–81.
23. Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92:578-96.
24. Shiloh R, Weizman A, Epstein Y, et al. Abnormal thermoregulation in drug-free male schizophrenia patients. Eur Neuropsychopharmacol. 2001;11:285–288.
25. Sharma RP, Janicak PG, Bissette G, Nemeroff CB. CSF neurotensin concentrations and antipsychotic treatment in schizophrenia and schizoaffective disorder. Am J Psychiatry. 1997;154:1019–1021.
26. Aslam AF, Aslam AK, Vasavada BC, Khan IA. Hypothermia: evaluation, electrocardiographic manifestations, and management. Am J Med. 2006;119:297–301.
27. Hale GM, Kane-Gill SL, Groetzinger L, Smithburger PL. An evaluation of adverse drug reactions associated with antipsychotic use for the treatment of delirium in the intensive care unit. J Pharm Pract. 2016;29:355-60.
28. Hellgren U, Julander I. Are white blood cell count, platelet count, erythrocyte sedimentation rate and C-reactive protein useful in the diagnosis of septicaemia and endocarditis? Scand J Infect Dis. 1986;18:487-8.
29. Reinhart K, Bauer M, Riedemann NC, Hartog CS. New approaches to sepsis: molecular diagnostics and biomarkers. Clin Microbiol Rev. 2012;25:609-34.
30. Kahveci F. Yoğun bakım hastalarında ateş-hipotermi. Turk J Intensive Care. 2008;6:7-12.
31. Mackowiak PA, Marling-Cason M, Cohen RL. Effects of temperature on antimicrobial susceptibility of bacteria. J Infect Dis. 1982;145:550-553.
32. Burk BG, Ward AH, Clark B. A case report of acute hypothermia during initial inpatient clozapine titration with review of current literature on clozapine-induced temperature dysregulations. BMC Psychiatry. 2020;20:290.
33. Goodbar NH, Foushee JA, Nash K, Connolly LA, Webster LM. Hypothermia associated with thioridazine use in an intellectually disabled patient. J Pharm Pract. 2016;29:250-2.

Yıl 2022, Cilt: 32 Sayı: 6, 658 - 665, 31.12.2022

Ömür İlban Muhammed Emin Zora Bülent Devrim Akçay Jale Bengi Çelik Faruk Çiçekci Mehmet Ali Baş Ates Duman

https://doi.org/10.54005/geneltip.1116922

Öz

Proje Numarası

Yok

Kaynakça

1. Boschi G, Launay N, Rips R. Neuroleptic-induced hypothermia in mice: lack of evidence for a central mechanism. J Pharmac. 1987;90:745–51.
2. Ginawi OT. Possible involvement of opioid receptors in moclobemide-induced hypothermia in mice. Pharmacol Res. 2003;48:237–40.
3. Asanami S, Shimono K. Species-level differences between mice and rats in regards to micronucleus induction with the hypothermia-inducing drug haloperidol. Mutat Res. 2009;676:102-5.
4. Van Marum RJ, Wegewijs MA, Loonen AJ, Beers E. Hypothermia following antipsychotic drug use. Eur J Clin Pharmacol. 2007;63:627-631.
5. Gocke E. Review of the genotoxic properties of chlorpromazine and related phenothiazines. Mutat Res. 1996;366:9-21.
6. Lopez-Munoz F, Alamo C, Cuenca E, et al. History of the discovery and clinical introduction of chlorpromazine. Ann Clin Psychiatry. 2005;17:113-135.
7. Adams F. Neuropsychiatric evaluation and treatment of delirium in the critically ill cancer patient. Cancer Bulletin. 1984;36:156-160.
8. Coppolo DP, May JJ. Self-extubations: A 12 month experience. Chest. 1990;98:165-169.
9. Robinson BR, Mueller EW, Henson K, et al. An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay. J Trauma. 2008;65:517-26.
10. Adams F. Emergency intravenous sedation of the delirious medically ill patient. J Clin Psychiatry. 1988;49:22-26.
11. Marks W. Physical restraints in the practice of medicine: Current concepts. Arch Intern Med. 1992;152:2203-6.
12. Sakkat A, Alquraini M, Aljazeeri J, et al. Temperature control in critically ill patients with fever: A meta-analysis of randomized controlled trials. J Crit Care. 2021;61:89-95.
13. Dippel DW, van Breda EJ, van Gemert HM, et al. Effect of paracetamol (acetaminophen) on body temperature in acute ischemic stroke: a double-blind, randomized phase II clinical trial. Stroke. 2001;32:1607-12.
14. Gramish JA, Kopp BJ, Patanwala AE. Effect of amantadine on agitation in critically ill patients with traumatic brain injury. Clin Neuropharmacol. 2017;40:212-216.
15. Gélinas C. Pain assessment in the critically ill adult: Recent evidence and new trends. Intensive Crit Care Nurs. 2016;34:1-11.
16. Severgnini P, Pelosi P, Contino E, et al. Accuracy of critical care pain observation tool and behavioral pain scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study. J Intensive Care. 2016;4:68.
17. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45.
18. Young DM. Risk factors for hypothermia in psychiatric patients. Ann Clin Psychiatry. 1996;8:93–97.
19. Turkish Society of Anaesthesiology and Reanimation Practice Guideline for Prevention of Unintentional Perioperative Hypothermia. Turk J Anaesth Reanim. 2013;41:188-90.
20. Kreuzer P, Landgrebe M, Wittmann M, et al. Hypothermia associated with antipsychotic drug use: a clinical case series and review of current literature. J Clin Pharmacol. 2012;52:1090-7.
21. Zonnenberg C, Bueno-de-Mesquita JM, Ramlal D, Blom D. Hypothermia due to antipsychotic medication: A Systematic Review. Front Psychiatry. 2017;8:1-9.
22. Kovács E, Jenei Z, Horváth A, et al. Physiologic effects of hypothermia. Orv Hetil. 2011;152:171–81.
23. Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92:578-96.
24. Shiloh R, Weizman A, Epstein Y, et al. Abnormal thermoregulation in drug-free male schizophrenia patients. Eur Neuropsychopharmacol. 2001;11:285–288.
25. Sharma RP, Janicak PG, Bissette G, Nemeroff CB. CSF neurotensin concentrations and antipsychotic treatment in schizophrenia and schizoaffective disorder. Am J Psychiatry. 1997;154:1019–1021.
26. Aslam AF, Aslam AK, Vasavada BC, Khan IA. Hypothermia: evaluation, electrocardiographic manifestations, and management. Am J Med. 2006;119:297–301.
27. Hale GM, Kane-Gill SL, Groetzinger L, Smithburger PL. An evaluation of adverse drug reactions associated with antipsychotic use for the treatment of delirium in the intensive care unit. J Pharm Pract. 2016;29:355-60.
28. Hellgren U, Julander I. Are white blood cell count, platelet count, erythrocyte sedimentation rate and C-reactive protein useful in the diagnosis of septicaemia and endocarditis? Scand J Infect Dis. 1986;18:487-8.
29. Reinhart K, Bauer M, Riedemann NC, Hartog CS. New approaches to sepsis: molecular diagnostics and biomarkers. Clin Microbiol Rev. 2012;25:609-34.
30. Kahveci F. Yoğun bakım hastalarında ateş-hipotermi. Turk J Intensive Care. 2008;6:7-12.
31. Mackowiak PA, Marling-Cason M, Cohen RL. Effects of temperature on antimicrobial susceptibility of bacteria. J Infect Dis. 1982;145:550-553.
32. Burk BG, Ward AH, Clark B. A case report of acute hypothermia during initial inpatient clozapine titration with review of current literature on clozapine-induced temperature dysregulations. BMC Psychiatry. 2020;20:290.
33. Goodbar NH, Foushee JA, Nash K, Connolly LA, Webster LM. Hypothermia associated with thioridazine use in an intellectually disabled patient. J Pharm Pract. 2016;29:250-2.

Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Klinik Tıp Bilimleri
Bölüm	Original Article
Yazarlar	Ömür İlban 0000-0001-8320-3150 Muhammed Emin Zora 0000-0001-7919-3578 Bülent Devrim Akçay 0000-0002-6308-9327 Jale Bengi Çelik 0000-0003-2167-9967 Faruk Çiçekci 0000-0002-3248-0745 Mehmet Ali Baş 0000-0001-8339-7418 Ates Duman 0000-0003-0394-2485
Proje Numarası	Yok
Erken Görünüm Tarihi	31 Aralık 2022
Yayımlanma Tarihi	31 Aralık 2022
Gönderilme Tarihi	15 Mayıs 2022
Yayımlandığı Sayı	Yıl 2022 Cilt: 32 Sayı: 6

Kaynak Göster

Vancouver	İlban Ö, Zora ME, Akçay BD, Çelik JB, Çiçekci F, Baş MA, Duman A. The Acute Effect of Chlorpromazine on Body Temperature in Intensive Care Unit Patients. Genel Tıp Derg. 2022;32(6):658-65.

Makale Dosyaları

Tam Metin

Genel Tıp Dergisi Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı (CC BY NC) ile lisanslanmıştır.