myxedema coma


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coma

 [ko´mah]
a state of unconsciousness from which the patient cannot be aroused, even by powerful stimuli. Traumatic brain injuries are the most frequent cause; other causes include severe uncontrolled diabetes mellitus, liver disease, kidney disease, and neurologic conditions. Evaluation of a patient in a coma is comprehensive. The underlying cause should be identified so that appropriate treatment can be initiated. magnetic resonance imaging, electroencephalography, and brainstem auditory evoked potentials give information about electrical activity of the brain in a patient who is comatose, although the results are not predictive of recovery. Some patients are able to emerge from a coma. In others, the coma may progress to a persistent vegetative state in which the functions of the brainstem and circulation remain relatively intact or may be supported with assistive technologies. Patients in irreversible coma may meet the criteria of brain death.
Schematic representation of major brain stem reflexes used in coma examination. From Marx et al., 2002.
Patient Care. Assessment of the patient in a coma includes an evaluation of vital signs, determination of level of consciousness, neuromuscular responses, and reaction of the pupils to light. In most hospitals a standard form is used to measure and record the patient's responses to stimuli in objective terms. The glasgow coma scale is a standardized tool that aids in assessing a comatose patient and eliminates the use of ambiguous and easily misinterpreted terms such as unconscious and semicomatose. Additional assessment data are gathered relating to the underlying cause and the patient's immobility; these include evaluation of the gag and corneal reflexes. In the absence of gag reflex, regurgitation and aspiration are potential problems.

Abnormal rigidity and posturing in response to noxious stimuli are motor responses to coma. Decorticate rigidity is abnormal flexor posturing, with the arms, wrists, and fingers drawn up. The legs may be extended with plantar flexion. This type of rigidity usually indicates a lesion in the cerebral hemispheres or a disruption of the corticospinal tracts. Decerebrate rigidity is abnormal extensor posturing: in response to painful stimuli the extremities extend rigidly and the palms turn outward. This type of rigidity is indicative of damage to the brainstem and as a rule is a sign of greater cerebral impairment than is decorticate rigidity.

Comatose patients are predisposed to all the hazards of immobility, including impairment of skin integrity and development of pressure ulcers and contractures. A multidisciplinary, coordinated plan of care is essential. Families should be encouraged to be actively involved in care of the patient. The health care team should also recognize the family's need for support; the emotional and financial impacts of coma are usually significant.
alcoholic coma coma accompanying severe alcoholic intoxication.
alpha coma coma in which there are electroencephalographic findings of dominant alpha-wave activity.
diabetic coma the coma of severe diabetic acidosis; see also diabetes mellitus.
hepatic coma coma accompanying cerebral damage resulting from degeneration of liver cells, especially that associated with cirrhosis of the liver.
hyperglycemic hyperosmolar nonketotic coma (hyperosmolar nonketotic coma) see hyperglycemic hyperosmolar nonketotic coma.
irreversible coma brain death.
Kussmaul's coma the coma and air hunger of diabetic acidosis.
myxedema coma an often fatal complication of long-term hypothyroidism in which the patient is comatose with hypothermia, depression of respiration, bradycardia, and hypotension; usually seen in elderly patients during cold weather.
coma vigil locked-in syndrome.

myxedema

Endocrinology Severe hypothyroidism characterized by yellowish discoloration, nonpitting edema, especially facial, accompanied by periorbital puffiness, puffy lips, and tongue, hoarse voice and sluggish movement; myxedema elicits several reactions a sui generis
Myxedema
Myxedema coma A complication of severe hypothyroidism, characterized by a loss of consciousness, which may be iatrogenic–sedatives in hypothyroidism are very slowly metabolized, may be due to infections or cold exposure; or rarely, occurring spontaneously Mortality 20-50%
Myxedema madness A condition most common in the elderly, characterized by impaired hearing and memory, acalculia, somnolence, psychologic withdrawal, and paranoia
Myxedema megacolon Pseudo-obstruction due to ↓ GI motility
Myxedema wit Confabulation or use of humorous non-sequiturs by a hypothyroid Pt in order to draw the interviewer's attention away from the Pt's impaired memory  

myxedema coma

Unresponsiveness or lethargy that results from severe or neglected hypothyroidism. It is marked by neurological dysfunction, by respiratory depression, and by lowered body temperature, blood pressure, blood sugar, and serum sodium. The condition is an endocrinological crisis that requires treatment with thyroid and adrenocortical hormones, fluids, and glucose; gradual rewarming; ventilatory support; and intensive monitoring.
See also: coma

coma

a state of unconsciousness from which the patient cannot be aroused, even by powerful stimuli.

alpha coma
coma in which there are electroencephalographic findings of dominant alpha-wave activity.
diabetic coma
the coma of severe diabetic acidosis. See also diabetes mellitus.
hepatic coma
results from reversible biochemical abnormalities of the cerebrum, caused by elevated blood levels of toxic substances such as ammonia, amino acids, short-chain fatty acids and beta hydroxylated biogenic amines that accumulate in severe liver disease. See also hepatic encephalopathy.
irreversible coma
coma in which for a period of 24 hours there is complete nonreceptivity and nonresponsivity even to the most intensely painful stimuli, no spontaneous movement or breathing, absence of elicitable reflexes, and a flat electroencephalogram. Called also brain death.
myxedema coma
the mental stupor caused by severe hypothyroidism; seen most often in Doberman pinchers, it is associated with hypoventilation, hypothermia, hypotension and bradycardia. Death may occur.
References in periodicals archive ?
Untreated severe myxedema coma may have serious problems.
CONCLUSION: Myxedema coma should be thought of in cases of delayed emergence from anaesthesia due to increase in proportion of hypothyroid patients and high index of suspicion is required in type-2 diabetes mellitus patients.
Emergency care physicians often are not aware of an incoming patient's thyroid disease history, and without readily available confirmatory laboratory tests, it is difficult to differentiate between myxedema coma and other similar presenting conditions.