Thursday, December 08, 2005

Friday December 9, 2005
7 Pearls re. Myxedema Coma

Myxedema Coma is a medical emergency but being an intensivist 7 pearls are worth remembering:

Myxedema Coma is a clinical diagnosis and treatment should not be delayed for laboratory confirmation.

Even if enteral route is available - IV Thyroid hormone (T4 or T3) replacement is needed as GI absorption is unreliable.

T4 is preferable if underlying cadiac co-morbidity is suspected.

Simultaneously steroids should also be started after random cortisol level is drawn.

Adding prophylactic antibiotics is not a bad idea.

Hypotension is not due to volume depletion so avoid aggressive fluid resuscitation.

Thermometers that can record below 90°F (32.2 C) is preferable.

Read intereating case study with discussion and treatment options on Myxedema Crisis
here from Israeli Journal of Emergency Medicine – in pdf - (Vol. 5, No. 4 Oct 2005)