2. 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.
3.
4.
5.
6. 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
7. 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
8. 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
9. Examination
generalized puffiness, periorbital edema, ptosis,
macroglossia, and her extremities are dry and
cool with nonpitting edema.
INVESTIGATION
10.
11. 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.
12.
13.
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15.
16.
17.
18.
19. 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
20. 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
21. 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: