What supportive measures are included in the treatment of myxedema coma (crisis)?

Updated: Oct 10, 2018
  • Author: Mohsen S Eledrisi, MD, FACP, FACE; Chief Editor: George T Griffing, MD  more...
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Answer

Treat hypothermia with passive rewarming using ordinary blankets and a warm room. Active rewarming using external devices carries a risk of vasodilatation and worsening hypotension and should be avoided. The use of a rectal probe helps to determine the true core temperature and to monitor rewarming.

Treat associated infection. Given the severity of the condition, infection should always be considered and empiric broad-spectrum of antibiotics be considered until appropriate cultures are proven negative.

Correct severe hyponatremia with saline and free water restriction.

Correct hypoglycemia with intravenous dextrose.

Hypotension is usually corrected with thyroid hormone therapy. If blood pressure continues to be low, cautious use of intravenous fluids with normal saline is advised. Refractory hypotension can be treated with vasopressors such as dopamine, but patients should be weaned off the vasopressor as soon as possible because of the risk of pressor-induced ischemic event. [2]

Patients who are awake, no longer dependent on a ventilator, and medically stable may be transferred from the intensive care unit to a medical ward.


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