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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Myxoedema coma is a medical emergency with high mortality. In this study, clinical response and plasma variations of thyroid hormones were analysed in 7 patients, 6 presenting with myxoedema coma and one with myxoedema ileus. These patients were treated with intravenous or oral l-thyroxine (l-T4). 1000 mu l-T4 iv were administered in two patients. Within 3 h, plasma T4 and triiodothyronine (T3) reached a peak upper normal range, then diminished slowly during 5-9 days. The 5 remaining patients were treated with 500 micrograms l-T4 po on the first day, then 100 micrograms l-T4 daily by mouth. Plasma T4 and T3 increased slowly, remaining in hypothyroid range but clinical response (assessed on mental status, pulse rate and body temperature) occurred within 24-72 h. Cortisone therapy was used in 3 patients. Two patients died of myocardial infarction, or septicemia, one while receiving cortisone therapy and i.v. l-T4, another one treated only by oral l-T4. This study suggests: 1) oral absorption of l-T4 is variable, but clinical response occurs quickly even in myxoedema ileus; 2) the intravenous route involves high peaks of plasma T4 and T3; 3) peripheral conversion of T4 to T3 allows gradually T3 delivery to organ systems, even if only l-T4 is used and 4) initial and daily dosage determinations need further studies.
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PMID:Myxoedema coma: response of thyroid hormones with oral and intravenous high-dose L-thyroxine treatment. 203 20

Myxoedema coma is a rare and life-threatening illness the outcome of which has not been robustly studied in large numbers, partly due to its low incidence. Dutta and colleagues have explored outcome predictors in a developing country where access to thyroid function tests is more limited than in the Western world. Cardiovascular instability, reduced consciousness, persistent hypothermia, and sepsis all contributed to a poorer outcome, as has been demonstrated before, but a generic outcome predictor model was shown to be useful in this group of patients. Unfortunately, this observational study was unable to show differences in outcome based on replacement treatment methods and the mortality remains at 40%.
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PMID:Predictors of outcome in myxoedema coma. 1817 46

Myxoedema coma is a rare and extreme presentation of hypothyroidism. It has a poor prognosis due to multisystem decompensation, and demands prompt but careful management in a high-dependency / intensive care setting. Early recognition of hypercapnia, hyponatraemia, and sepsis are especially important. Treatment should begin on suspicion of the diagnosis and can be life-saving. Intravenous thyroid hormone replacement is required at first, with steroid cover, although the optimum dose regimen remains unclear.
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PMID:Myxoedema coma. 2165 18

Myxedema coma, a rare but fatal emergency, is an extreme expression of hypothyroidism. We describe a 51-year-old male patient who has discontinued hypothyroidism treatment 10 months earlier and developed lethargy, edema, and cold intolerance symptoms. He also had a previous diagnosis of neurofibromatosis. After admission, he progressed to respiratory insufficiency and coma. The prompt recognition of the condition, thyroid hormone replacement, and management of the complications (hypoventilation, cardiogenic shock associated with swinging heart, adrenal and renal insufficiency and sepsis), resulted in a favorable evolution.
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PMID:[Myxedema coma in a patient with type 1 neurofibromatosis: rare association]. 2440 22

Patients presenting to the emergency department with hypothermia are rare and often require prompt diagnosis and management. Myxedema coma, which may cause severe hypothermia, is a true endocrine emergency requiring early and appropriate treatment. We report on a 47-year-old woman with a history of hyperthyroidism who underwent thyroidectomy 5 years previously, with no regular medication or examinations. She presented to the emergency department with a 1-month history of progressive dyspnea associated with general weakness. She also showed hypothermia, decreased mental status, and general edema. Echocardiography revealed increased pericardial effusion without tamponade. Laboratory examination suggested myxedema coma and hypothyroidism. She received thyroxine, glucocorticoid supplement, and intensive supportive care, after which she gradually improved and was discharged. This case suggests that myxedema coma should be considered in patients with hypothyroidism or a history of thyroidectomy who present with change in consciousness, hypothermia, or other symptoms related to critical or slow presentation in multiple organs. Moreover, long-standing hypothyroidism or precipitating acute events such as sepsis, cerebrovascular accidents, gastrointestinal bleeding, cold exposure, trauma, and some medications may also cause myxedema coma. Myxedema coma is associated with a high mortality, and patients suspected to be suffering from this condition should be treated without delay.
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PMID:Comatose patient with hypothermia, dyspnea, and general edema in the emergency department: a case report. 3011 Dec 6

This report describes the management of a patient with myxoedema coma masquerading as an acute stroke (with or without 'cold sepsis'). Myxoedema coma is an endocrine emergency occurring when physiological adaptations to untreated hypothyroidism are overwhelmed by an acute precipitant. Even promptly treated, it has an associated mortality of up to 50%.
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PMID:Myxoedema Coma Masquerading as Acute Stroke. 3266 24

Hypothermic patients are rare encountered in emergency department (ED). It often represents critical condition that needs prompt management and diagnosis. Myxedema coma, which may cause severe hypothermia, is truly an endocrine emergency and needs early recognition and proper treatment. We present a case of a 47-year-old female with a history of hyperthyroidism status post thyroidectomy was brought to the ED because of progressive dyspnea associated with general weakness for one month. Hypothermia with decreased mental status and general edema were also noted. Hypothyroidism was confi rmed by laboratory examination and myxedema coma was diagnosed. The patient recovered well and there was no complication noted after intensive care with supplements of thyroxine and glucocorticoid. In conclusion, myxedema coma should be considered in decrease mental status and hypothermic patients with a history of hypothyroidism or thyroidectomy. Besides, long-standing hypothyroidism or encountering precipitating acute events, such as sepsis, cerebrovascular accident, gastrointestinal bleeding, exposure to cold, trauma or certain medications may also cause this condition. High mortality rate was reported, and the treatment should be instituted in patient with presumed myxedema coma without delay.
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PMID:Myxedema Coma Patient in Emergency Department: A Case Report. 3299 92