Myxedema Coma

Q: All of the following are the signs and symptoms of myxedema coma except?

A) Hypernatremia 
B) Hypothermia 
C) Hypoventilation 
D) Hypoglycemia
E) Bradycardia


Answer: A

Myxedema coma causes hyponatremia in most of the patients. This is due to impairment of free water excretion due to inappropriate excess vasopressin secretion. Also impaired renal function and adrenal insufficiency plays a part. Treatment is to reverse hypothyroidism with thyroid replacement supported with steroid with mineralocorticoid activity. Simple mnemonic to remember treatment regimen of myxedema coma is 

R = Rewarming 
I = Isotonic Saline
T = Thyroid replacement
S = Steroid 


#endocrinology
#electrolytes




References:

1. Iwasaki Y, Oiso Y, Yamauchi K, et al. Osmoregulation of plasma vasopressin in myxedema. J Clin Endocrinol Metab 1990; 70:534. 

2.  Popoveniuc G, Chandra T, Sud A, et al. A diagnostic scoring system for myxedema coma. Endocr Pract 2014; 20:808.

3. Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid 2014; 24:1670.