Myxedema coma laboratory findings: Difference between revisions
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==Laboratory Findings== | ==Laboratory Findings== | ||
Myxedematous coma should be considered in any patient who is comatose or who has some degree of deterioration of the sensorium with hypothermia or absence of fever in the presence of infection, hyponatremia and / or hypercapnia. Performing a thyroid routine test is considered best initial step in management of patients with myxedema coma.<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><ref name="pmid17724938">{{cite journal |vauthors=Finora K, Greco D |title=Hypothyroidism and myxedema coma |journal=Compend Contin Educ Vet |volume=29 |issue=1 |pages=19–31; quiz 31–2 |year=2007 |pmid=17724938 |doi= |url=}}</ref> | Myxedematous coma should be considered in any patient who is comatose or who has some degree of deterioration of the sensorium with hypothermia or absence of fever in the presence of infection, hyponatremia and / or hypercapnia. Performing a thyroid routine test is considered best initial step in management of patients with myxedema coma.<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><ref name="pmid17724938">{{cite journal |vauthors=Finora K, Greco D |title=Hypothyroidism and myxedema coma |journal=Compend Contin Educ Vet |volume=29 |issue=1 |pages=19–31; quiz 31–2 |year=2007 |pmid=17724938 |doi= |url=}}</ref><ref name="pmid16374153">{{cite journal |vauthors=Stevens RD, Bhardwaj A |title=Approach to the comatose patient |journal=Crit. Care Med. |volume=34 |issue=1 |pages=31–41 |year=2006 |pmid=16374153 |doi= |url=}}</ref> | ||
*Serum TSH should be measured to distinguish primary hypothyroidism from the central. | *Serum TSH should be measured to distinguish primary hypothyroidism from the central. | ||
*TSH might not be so as would be expected due to the presence of concomitant severe systemic disease("sick hypothyroid syndrome"). | *TSH might not be so as would be expected due to the presence of concomitant severe systemic disease("sick hypothyroid syndrome"). | ||
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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
Myxedematous coma should be considered in any patient who is comatose or who has some degree of deterioration of the sensorium with hypothermia or absence of fever in the presence of infection, hyponatremia and / or hypercapnia. Performing a thyroid routine test is considered best initial step in management of patients with myxedema coma.
Laboratory Findings
Myxedematous coma should be considered in any patient who is comatose or who has some degree of deterioration of the sensorium with hypothermia or absence of fever in the presence of infection, hyponatremia and / or hypercapnia. Performing a thyroid routine test is considered best initial step in management of patients with myxedema coma.[1][2][3]
- Serum TSH should be measured to distinguish primary hypothyroidism from the central.
- TSH might not be so as would be expected due to the presence of concomitant severe systemic disease("sick hypothyroid syndrome").
- The use of certain drugs such as dopamine or glucocorticoids also decrease the levels of TSH.
- The levels of T4 and T3 (total and free fractions) will always be low.
- In all cases measure cortisol and ACTH to evaluate or rule out the presence of primary adrenal insufficiency or secondary school.
- CBC shows Anemia, leucopenia, hyponatremia, increased lactic dehydrogenase (LDH), creatine phosphokinase (CPK) and transaminases, hypercholesterolemia, increased creatinine and hypoglycemia.
- Blood gases will reveal hypoxemia, hypercapnia and acidosis.
Approach to Patient with altered level of conciousness
| Altered level of concoiousness COMA Stupor | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Assess ABC Airway Breathing Circulation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Seizure activity | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Identity the problem reassess | Diagnostic and therapatic administration of Thiamine 100mg Dextrose 50ml, 50% Nalaoxone 0.4mg | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No change in level of conciousness | Improvement in conciousness | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Perform labaratory tests CBC,Thyroid studies Blood glucose, CMP,BUN, creatinine LFT's Serum osmolality | Hypoglycemia or Narcotic overdose | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Abnormal | Normal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ↑TSH ↓T3 and T4 | ↑WBC | CMP abnormal | Check Head CT/MRI | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Myxedema coma | Sepsis Meningitis Encephalitis | Toxic encephalopathy | Abnormal | Normal | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Stroke Brain tumor Intracranial bleeding Cerebral edema Brain abscess | Perform lumbar puncture | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Abnormal | Normal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Increased ICP Infection | Psyciatric Disorders | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Wall CR (2000). "Myxedema coma: diagnosis and treatment". Am Fam Physician. 62 (11): 2485–90. PMID 11130234.
- ↑ Finora K, Greco D (2007). "Hypothyroidism and myxedema coma". Compend Contin Educ Vet. 29 (1): 19–31, quiz 31–2. PMID 17724938.
- ↑ Stevens RD, Bhardwaj A (2006). "Approach to the comatose patient". Crit. Care Med. 34 (1): 31–41. PMID 16374153.