Myxedema coma laboratory findings: Difference between revisions
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==Overview== | ==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== | ==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> | 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"). | ||
*The use of certain drugs such as dopamine or glucocorticoids also decrease the levels of TSH. | *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. | *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. | *In all cases measure [[cortisol]] and [[ACTH]] to evaluate or rule out the presence of [[primary adrenal insufficiency]] or secondary school. | ||
*CBC shows | *[[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. | *Blood gases will reveal [[hypoxemia]], [[hypercapnia]] and [[acidosis]]. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 00:50, 26 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
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.
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.