MYXEDEMA COMA: WAKE ME WHEN 2020 ENDS

Normal neurologic function requires a constantly balanced environment of electrolytes. Normal hepatic and renal function is critical in maintaining this balance while removing toxins, maintaining a physiologic pH and regulating the excretion of electrolytes. Nutritional intake provides essential nutrients but deficiencies can lead to characteristic syndromes such as Wernicke's encephalopathy and pellagra and exposure to neurotoxic substances such as heavy metals can lead to encephalopathy. Thyroid and adrenal dysfunction are common endocrine causes of encephalopathy and symptoms can often improve rapidly with treatment. A subset of idiopathic encephalopathy is increasingly being recognized as having an autoimmune basis, often presenting as a paraneoplastic process, and having a constellation of symptoms which can aide in the diagnosis. Timely recognition and treatment of the autoantibodies which target neural structures, with immunosuppressive therapy, can improve outcome in these patients. This review contains 4 figures, 3 tables, and 42 references. Key words: osmotic demyelination syndrome,hepatic encephalopathy, renal failure, triphasic waves, dialysis disequilibrium syndrome, Wernicke encephalopathy, Korsakoff syndrome, myxedema coma, Hashimoto encephalopathy

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Metabolic Encephalopathy - Part II

10.2310/vasc.1393 ◽

2019 ◽

Author(s):

Rick Gill ◽

Matthew McCoyd ◽

Sean Ruland ◽

José Biller

Keyword(s):

Nutritional Intake ◽

Osmotic Demyelination Syndrome ◽

Wernicke Encephalopathy ◽

Metabolic Encephalopathy ◽

Improve Outcome ◽

Myxedema Coma ◽

Hashimoto Encephalopathy ◽

Korsakoff Syndrome ◽

Dialysis Disequilibrium Syndrome ◽

Neurologic Function

Normal neurologic function requires a constantly balanced environment of electrolytes. Normal hepatic and renal function is critical in maintaining this balance while removing toxins, maintaining a physiologic pH and regulating the excretion of electrolytes. Nutritional intake provides essential nutrients but deficiencies can lead to characteristic syndromes such as Wernicke's encephalopathy and pellagra and exposure to neurotoxic substances such as heavy metals can lead to encephalopathy. Thyroid and adrenal dysfunction are common endocrine causes of encephalopathy and symptoms can often improve rapidly with treatment. A subset of idiopathic encephalopathy is increasingly being recognized as having an autoimmune basis, often presenting as a paraneoplastic process, and having a constellation of symptoms which can aide in the diagnosis. Timely recognition and treatment of the autoantibodies which target neural structures, with immunosuppressive therapy, can improve outcome in these patients. This review contains 4 figures, 3 tables, and 42 references. Key words: osmotic demyelination syndrome,hepatic encephalopathy, renal failure, triphasic waves, dialysis disequilibrium syndrome, Wernicke encephalopathy, Korsakoff syndrome, myxedema coma, Hashimoto encephalopathy

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A forgotten life-threatening medical emergency: myxedema coma

Emergency Care Journal ◽

10.4081/ecj.2016.5790 ◽

2016 ◽

Vol 12 (2) ◽

Author(s):

Elisa Pizzolato ◽

Alberto Peano ◽

Letizia Barutta ◽

Emanuele Bernardi ◽

Elena Maggio ◽

...

Keyword(s):

Life Support ◽

Neurological Status ◽

Medical Emergency ◽

Myxedema Coma ◽

Emergency Department Stay ◽

Life Threatening ◽

Appropriate Therapy ◽

Alithiasic Cholecystitis ◽

The Right ◽

Tomography Scan

Nowadays myxedema coma is a rare medical emergency but, sometimes, it still remains a fatal condition even if appropriate therapy is soon administered. Although physical presentation is very non-specific and diversified, physicians should pay attention when patients present with low body temperature and alteration of neurological status; the presence of precipitating events in past medical history can help in making a diagnosis. Here we discuss one such case: an 83-year-old female presented with abdominal pain since few days. Laboratory tests and abdomen computed tomography scan demonstrated alithiasic cholecystitis; she was properly treated but, during the Emergency Department stay she experienced a cardiac arrest. Physicians immediately started advance cardiovascular life support algorithm and she survived. Later on, she was admitted to the Intensive Care Unit where doctors discovered she was affected by severe hypothyroidism. Straightway they started the right therapy but, unfortunately, the patient died in a few hours.

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