myxedema-coma.pptx

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myxedema

Health & Medicine

Myxedema coma isastateof
decompensatedhypothyroidism.
Apersonmayhavelabvaluesidenticaltoa
"normal"hypothyroidstate,butastressfulevent
precipitatesthemyxedemacoma state.

Primarysymptomsofmyxedemacomaare
alteredmental status
lowbodytemperature.
Lowbloodsugar,
lowblooodpressure,
hyponatremia
, hypercapnia,
hypoxia,
slowedheartrate,andhypoventilation m

MyxedemacomawasfirstreportedbyOrdin
1879in London.
Itisararedisorder,withonlyapproximately
300casesdescribedintheliterature
typicallyelderly females
havelongstanding,undiagnosedhypothyroidism
Morethan90%of casesoccurduringwinter
months

A65-year-old womanwithnoknownpastmedical
historyisbroughttotheemergencydepartment
withalteredmentalstatus.On arrival,thepatient
but arousable.
Patient detailes
R.R =15 b/m pH-7.23
paCO2-63.7
paO2-71.2 –R.A
O2 = 92%
Na= 128 mEq/L

Examination
generalizedpuffiness,periorbitaledema,ptosis,
macroglossia,andherextremitiesaredryand
coolwithnonpittingedema.
INVESTIGATION

Thedifferentialdiagnosisofmyxoedemacomawill
includesothercausesofadeteriorationinmental
state:
Hypothermia.
Septic shock.
Psychiatric disorders
Dementia(includingAlzheimer's disease),Depression
Changesinmentalstatesecondarytoothermedical
conditionsanddrugs,Hypoglycaemia(mayco-exist)
Encephalitisandmeningitis,Hepaticencephalopathy
,
Cerebrovascular disease.

Admittointensivecareunitforcontinuous
monitoringof cardiovascularandpulmonary status
Supportivecare
ABC measures
Treathypothermiawithpassive rewarming
Treathyponatremiawithnormalsalineandfree-
waterrestriction

Thyroidhormone treatment
Levothyroxine (T4)
Loadingdose:300to400μgIVthen50to100μg
IV daily
untiloralmedicationcanbegiven
If suboptimalresponseconsiderconcurrent
liothyronine(T3): 5μgIVevery8 hr

Corticosteroid therapy
Firstdrawbaselinecortisollevelandstart
hydrocortisone100mgIV
,followedby50mgIV
every6to8 hr
Follow-upsteroid therapy:

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Myxedema coma is an extreme complication of hypothyroidism in which patients exhibit multiple organ abnormalities and progressive mental deterioration. The term myxedema is often used interchangeably with hypothyroidism and myxedema coma. Myxedema also refers to the swelling of the skin and soft tissue that occurs in patients who are hypothyroid. Myxedema coma occurs when the body's compensatory responses to hypothyroidism are overwhelmed by a precipitating factor such as infection.

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