HEPARIN-INDUCED PERSISTENT HYPERTHERMIA AND HYPONATREMIA IN A PATIENT WITH OPEN FRACTURE — A DIAGNOSTIC DILEMMA

Fever and hyponatremia in the post-operative period are a frequent observation. Drug-induced etiopathogenesis is a possibility that is often overlooked in such situations. Drug-induced pyrexia with hyponatremia in the post-operative period is often a diagnosis of exclusion. We present a 53-year-old male who was admitted to our hospital with an open tibia fracture and intravenous heparin was started for thrombophylaxis. The patient developed fever and hyponatremia. Usual causes of fever and hyponatremia were ruled out by clinical and laboratory evaluation. Upon discontinuation of heparin, the hyperthermia ceased, and serum sodium levels returned to baseline. Heparin is an anticoagulant widely used in clinical health practices for the prevention and treatment of thromboembolic disorders. Despite its efficacy, heparin is associated with several adverse drug reactions, most common being bleeding and heparin-induced thrombocytopenia (HIT). Heparin can also lead to osteoporosis, which is quite risky, particularly in women. Moreover, heparin-induced skin necrosis is a serious complication and manifests as necrotic lesions at the injection site. The rare adverse drug reactions to heparin, though serious, do not represent a prevalent health problem in the general population. This report aims to bring to the notice of practising clinicians two of the rare adverse effects of heparin, which are fever and hyponatremia in the postoperative period. This background sets a stage for further exploration into the mechanism, incidence and management of these adverse drug reactions with the goal of optimizing patient outcomes while minimizing risks.