Severe Hyperthermia With Altered Mental Status After Misoprostol Administration: Two Case Reports

Abstract

Misoprostols low cost and temperature stable profile lends itself to widespread usage for postpartum hemorrhage (PPH). A common side effect is fever; however, this more rarely can present as a profound fever with altered mental status. We present two patients who received misoprostol for PPH, after which both had severe hyperthermia and altered mental status and were managed with sepsis protocol and anti-convulsants. These cases illuminate the importance of treatment selection in the management of uterine atony and subsequent steps of care of severe hyperthermia given the risk for adverse events. There needs to be awareness of this uncommon complication with administration of misoprostol. Supportive care and inclusion of the medication adverse effect in the broad differential are essential during presentation of the rare event of severe hyperthermia with altered mental status. It is important to be aware of this adverse effect with administration of more than 600 g of misoprostol in the setting of PPH.

J Clin Gynecol Obstet. 2023;12(3):106-109
doi: https://doi.org/10.14740/jcgo918