Myxedema coma diagnostic criteria: Difference between revisions
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{{CMG}} ; {{AE}} {{ADG}} | {{CMG}} ; {{AE}} {{ADG}} | ||
==Overview== | ==Overview== | ||
The diagnosis of myxedema coma is made when the three key diagnostic features of myxedema coma are present, which include altered mental status, hypothermia or absence of fever | The diagnosis of myxedema coma is made when the three key diagnostic features of myxedema coma are present, which include altered mental status, [[hypothermia]] or absence of [[fever]] and a precipitating event such as cold exposure, infection, drugs. | ||
and a precipitating event such as cold exposure, infection, drugs. | |||
==Diagnostic criteria== | ==Diagnostic criteria== | ||
The diagnosis of myxedema coma is made when the following three key diagnostic features are present, which include:<ref name="pmid11130234">{{cite journal |vauthors=Wall CR |title=Myxedema coma: diagnosis and treatment |journal=Am Fam Physician |volume=62 |issue=11 |pages=2485–90 |year=2000 |pmid=11130234 |doi= |url=}}</ref> | The diagnosis of myxedema coma is made when the following three key diagnostic features are present, which include:<ref name="pmid11130234">{{cite journal |vauthors=Wall CR |title=Myxedema coma: diagnosis and treatment |journal=Am Fam Physician |volume=62 |issue=11 |pages=2485–90 |year=2000 |pmid=11130234 |doi= |url=}}</ref> | ||
* Altered mental status | * [[Altered mental status]] | ||
* Hypothermia or absence of fever | * [[Hypothermia]] or absence of [[fever]] | ||
* Precipitating event (cold exposure, infection, drugs) | * Precipitating event ([[cold exposure]], [[infection]], [[drugs]]) | ||
===Diagnostic scoring=== | |||
*Traditionally different scoring systems have been employed to assess the level of awareness or degree of severity of myxedema coma such as the Glasgow scale and others such as the SOFA (Sequential Organ Failure Assessment) and APACHE II (Acute Physiology and Chronic Health Evaluation) assessing the severity of an illness and predict [[mortality]].<ref name="pmid24518183">{{cite journal |vauthors=Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, Mete M, Desale S, Wartofsky L |title=A diagnostic scoring system for myxedema coma |journal=Endocr Pract |volume=20 |issue=8 |pages=808–17 |year=2014 |pmid=24518183 |doi=10.4158/EP13460.OR |url=}}</ref> | |||
{| class="wikitable" | |||
! colspan="7" |Diagnostic Scoring System for Myxedema Coma | |||
|- | |||
!Component | |||
! colspan="2" |Variable | |||
!Points | |||
!Component | |||
!Variable | |||
!Points | |||
|- | |||
| rowspan="3" |'''Thermoregulatory dysfunction''' | |||
| colspan="2" |>35 | |||
|0 | |||
| rowspan="3" |'''Gastro-intestinal''' | |||
|[[Anorexia]]/[[abdominal pain]]/[[constipation]] | |||
|5 | |||
|- | |||
| colspan="2" |32-35 | |||
|10 | |||
|Decreased intestinal [[motility]] | |||
|15 | |||
|- | |||
| colspan="2" |<32 | |||
|20 | |||
|[[Paralytic ileus]] | |||
|20 | |||
|- | |||
| rowspan="4" |'''Central nervous system effects''' | |||
| colspan="2" |Somnolent/[[lethargic]] | |||
|10 | |||
| rowspan="2" |'''Precipitating event''' | |||
|Absent | |||
|0 | |||
|- | |||
| colspan="2" |Obtunded | |||
|15 | |||
|Present | |||
|10 | |||
|- | |||
| colspan="2" |[[Stupor]] | |||
|20 | |||
| rowspan="5" |'''Metabolic disturbances''' | |||
|[[Hyponatremia]] | |||
|10 | |||
|- | |||
| colspan="2" |[[Coma]]/[[seizures]] | |||
|30 | |||
|[[Hypoglycemia]] | |||
|10 | |||
|- | |||
| rowspan="6" |'''Cardiovascular''' | |||
| rowspan="3" |[[Bradycardia]] | |||
|Absent | |||
|0 | |||
|[[Hypoxemia]] | |||
|10 | |||
|- | |||
|50-59 | |||
|10 | |||
|[[Hypercarbia]] | |||
|10 | |||
|- | |||
|40-49 | |||
|20 | |||
|Decrease in [[GFR]] | |||
|10 | |||
|- | |||
| colspan="2" |EKG changes | |||
|10 | |||
| rowspan="3" |'''Others''' | |||
|[[Pleural effusions]] | |||
|10 | |||
|- | |||
| colspan="2" |[[Pericardial effusion|Pericardia]]<nowiki/>l effusion | |||
|10 | |||
|[[Pulmonary edema]] | |||
|15 | |||
|- | |||
| colspan="2" |[[Cardiomegaly]] | |||
|15 | |||
|[[Hypotension]] | |||
|20 | |||
|- | |||
| colspan="7" | | |||
* Abbreviations: [[EKG]] = [[Electrocardiograms|electrocardiogram]]; [[GFR]] = [[glomerular filtration rate]]. | |||
* A score of 60 or higher is highly suggestive/diagnostic of myxedema coma. | |||
* A score of 25 to 59 is suggestive of risk for myxedema coma, and a score below 25 is unlikely to indicate myxedema coma. | |||
* Other [[EKG]] changes: [[QT]] prolongation, or low voltage complexes, or [[Bundle branch block|bundle branch blocks]], or nonspecific ST-T changes, or [[Heart block|heart blocks]] | |||
|} | |||
{| | |||
|} | |||
*Diagnostic scoring of [[myxedema coma]] | |||
**A score greater than 60 is highly suggestive / diagnosis of myxedema coma. | |||
**A score between 29-59 is suggestive of [[coma]] risk myxedema. | |||
**A score lower than 25 makes the diagnosis unlikely of myxedema coma. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 19:55, 20 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
The diagnosis of myxedema coma is made when the three key diagnostic features of myxedema coma are present, which include altered mental status, hypothermia or absence of fever and a precipitating event such as cold exposure, infection, drugs.
Diagnostic criteria
The diagnosis of myxedema coma is made when the following three key diagnostic features are present, which include:[1]
- Altered mental status
- Hypothermia or absence of fever
- Precipitating event (cold exposure, infection, drugs)
Diagnostic scoring
- Traditionally different scoring systems have been employed to assess the level of awareness or degree of severity of myxedema coma such as the Glasgow scale and others such as the SOFA (Sequential Organ Failure Assessment) and APACHE II (Acute Physiology and Chronic Health Evaluation) assessing the severity of an illness and predict mortality.[2]
| Diagnostic Scoring System for Myxedema Coma | ||||||
|---|---|---|---|---|---|---|
| Component | Variable | Points | Component | Variable | Points | |
| Thermoregulatory dysfunction | >35 | 0 | Gastro-intestinal | Anorexia/abdominal pain/constipation | 5 | |
| 32-35 | 10 | Decreased intestinal motility | 15 | |||
| <32 | 20 | Paralytic ileus | 20 | |||
| Central nervous system effects | Somnolent/lethargic | 10 | Precipitating event | Absent | 0 | |
| Obtunded | 15 | Present | 10 | |||
| Stupor | 20 | Metabolic disturbances | Hyponatremia | 10 | ||
| Coma/seizures | 30 | Hypoglycemia | 10 | |||
| Cardiovascular | Bradycardia | Absent | 0 | Hypoxemia | 10 | |
| 50-59 | 10 | Hypercarbia | 10 | |||
| 40-49 | 20 | Decrease in GFR | 10 | |||
| EKG changes | 10 | Others | Pleural effusions | 10 | ||
| Pericardial effusion | 10 | Pulmonary edema | 15 | |||
| Cardiomegaly | 15 | Hypotension | 20 | |||
| ||||||
- Diagnostic scoring of myxedema coma
- A score greater than 60 is highly suggestive / diagnosis of myxedema coma.
- A score between 29-59 is suggestive of coma risk myxedema.
- A score lower than 25 makes the diagnosis unlikely of myxedema coma.
References
- ↑ Wall CR (2000). "Myxedema coma: diagnosis and treatment". Am Fam Physician. 62 (11): 2485–90. PMID 11130234.
- ↑ Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, Mete M, Desale S, Wartofsky L (2014). "A diagnostic scoring system for myxedema coma". Endocr Pract. 20 (8): 808–17. doi:10.4158/EP13460.OR. PMID 24518183.