Pt if feeling cold + shivering what can we give?
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Here's a concise clinical answer on managing a patient who is feeling cold and shivering:
Management of Shivering / Feeling Cold
Why it matters
Shivering significantly increases oxygen consumption, catecholamine release, cardiac output, heart rate, blood pressure, and intracranial/intraocular pressure — increasing cardiovascular morbidity, especially in older patients.
First-line: Non-pharmacological (Prevention is optimal)
- Warm blankets / forced-air warming
- Warm IV fluids
- Minimize thermal loss (the primary cause is perioperative/environmental hypothermia)
Pharmacological Options
| Drug | Dose | Notes |
|---|---|---|
| Meperidine (Pethidine) | 12.5–35 mg IV | Drug of choice — uniquely effective among opioids; disproportionately reduces the shivering threshold via α₂β-adrenoceptor activity |
| Tramadol | 0.5 mg/kg IV (35–220 mg range) | As effective as meperidine in studies; good alternative |
| Clonidine | Low dose IV | α₂-agonist; useful adjunct |
| Ondansetron | Standard antiemetic dose | Also has anti-shivering properties |
| Ketamine | 0.5 mg/kg | Useful when shivering is remifentanil-induced; prevents opioid-tolerance-related shivering |
Key Points
- Meperidine is the classic go-to drug for acute shivering — its anti-shivering mechanism is unique and distinct from its opioid analgesic effect.
- Tramadol (0.5 mg/kg) is equally effective in evidence-based trials and avoids meperidine's serotonergic risks.
- Avoid meperidine in patients on MAOIs (risk of serotonin syndrome).
- In post-anesthetic shivering from remifentanil, ketamine infusion is preferred.
— Miller's Anesthesia, 10e, p. 2733–2734; Morgan & Mikhail's Clinical Anesthesiology, 7e, p. 2116
Inj. Hydrocort dose in adult patint
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The textbooks didn't return a direct hydrocortisone dosing table, so here is the well-established clinical reference data:
Inj. Hydrocortisone (Hydrocortisone Sodium Succinate) — Adult Doses
By Indication
| Indication | Dose | Route | Frequency |
|---|---|---|---|
| Anaphylaxis / Allergic emergency | 200 mg | IV slow bolus | Stat; repeat 4–6 hourly if needed |
| Acute adrenal crisis (Addisonian crisis) | 100 mg stat, then 100 mg every 6–8 hrs | IV | For 24–48 hrs, then taper |
| Stress dosing (surgical cover) | 100 mg at induction, then 50–100 mg every 8 hrs | IV/IM | For 24–48 hrs |
| Septic shock (refractory) | 200–300 mg/day in divided doses or continuous infusion | IV | Until vasopressors weaned |
| Severe asthma / Status asthmaticus | 100–200 mg | IV | Every 6 hrs |
| Cerebral edema / Acute inflammation | 100–500 mg | IV slow infusion | Every 2–6 hrs depending on response |
Administration
- Give slowly IV over 2–5 minutes (rapid bolus can cause cardiovascular collapse, especially at high doses)
- Can also be given IM when IV access unavailable
- Reconstitute with water for injection or Normal Saline
Key Points
- The standard "stat" dose in most emergencies = 100–200 mg IV
- In adrenal crisis, always give IV fluids (0.9% NaCl) simultaneously
- Once stable, convert to oral hydrocortisone and taper
- Maximum daily dose used in critical illness: up to 300–400 mg/day
Quick memory aide: "100 mg for stress, 200 mg for anaphylaxis, 300 mg/day for septic shock"
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