myxedema coma
TRANSCRIPT
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By- Dr. D.kushbu
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Myxedema coma is a state of decompensated hypothyroidism.
A person may have lab values identical to a "normal" hypothyroid state, but a stressful event precipitates the myxedema coma state.
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Primary symptoms of myxedema coma are altered mental status low body temperature. Low blood sugar, low blooodpressure, hyponatremia , hypercapnia, hypoxia, slowed heart rate, and hypoventilation m
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Myxedema coma was first reported by Ord in 1879 in London.
It is a rare disorder, with only approximately 300 cases described in the literature typically elderly females have longstanding, undiagnosed
hypothyroidism More than 90% of cases occur during winter months
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A 65-year-old woman with no known past medical history is brought to the emergency department with altered mental status. On arrival, the patient but arousable.
Patient detailes R.R =15 b/m pH-7.23 O2 = 92% paCO2-63.7 Na = 128 mEq/L paO2-71.2 –R.A
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Examination generalized puffiness, periorbital edema,
ptosis, macroglossia, and her extremities are dry
and cool with nonpitting edema. INVESTIGATION
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The differential diagnosis of myxoedema coma will includes other causes of a deterioration in mental state:
Hypothermia. Septic shock. Psychiatric disorders Dementia (including Alzheimer's
disease),Depression Changes in mental state secondary to other
medical conditions and drugs,Hypoglycaemia (may co-exist)
Encephalitis and meningitis, Hepatic encephalopathy, Cerebrovascular disease.
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Admit to intensive care unit for continuous monitoring of cardiovascular and pulmonary status
Supportive care ABC measures Treat hypothermia with passive rewarming Treat hyponatremia with normal saline and
free-water restriction
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Thyroid hormone treatment Levothyroxine (T4) Loading dose: 300 to 400 μg IV then 50 to
100 μg IV daily until oral medication can be given If suboptimal response consider concurrent
liothyronine (T3): 5μg IV every 8 hr
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Corticosteroid therapy First draw baseline cortisol level and start
hydrocortisone 100mg IV, followed by 50 mg IV every 6 to 8 hr
Follow-up steroid therapy:
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