METABOLIC DISORDER CASE#1 1
MetabolicDisorders Case #1
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The paper talks aboutthe etiology, signs and symptoms, medical treatment, and thehealthcare approach pertinent to an 84-year-old male patientsuffering from Myxedema coma while receiving post-THA (Total hiparthroplasty) rehab.
Keywords:Myxedema coma, metabolic disorder, hypothyroidism
An 84-year-old male patient was admitted to ICU while he wasreceiving post-THA rehab after a 2 week hospitalization. He issuffering from Myxedema coma. Therefore, this paper will discuss theetiology, signs and symptoms, medical treatment, and the healthcareapproach appropriate for the patient.
The patient’s diagnosis
Thepatient is suffering from Myxedema coma. According to Irwin &Rippe (2012), if a patient has (or has a history of) hypothyroidismthen the common causes of Myxedema coma are: not being careful totake the prescribed thyroid medicines, the use of medications suchas- tranquilizers, lithium, amiodarone, phenothiazines etc., surgery,trauma, stroke, heart failure, and infections (particularly urine andlung infections). In this case, the patient total hip arthroplasty,he was on amiodarone, and he had a history of hypothyroidism,myocardial infarction and congestive heart failure. Together allthese factors contributed to his Myxedema coma.
Signs and Symptoms
Mathewet al. (2011) pointed out some common signs and symptoms of Myxedemacoma. They are as follows- difficulty breathing, inflammation in thebody, low temperature in the body thereby feeling cold, diminishedmental ability such as- being less alert and more confused, weakness,impaired memory, depression, slow heart rate, imbalanced thyroidfunctions and fatigue. In this case, the patient was less alert andmore confused, his body temperature was low, he had difficultybreathing, his thyroid functions were imbalanced and his heart ratewas slow.
Medical Treatment for the Patient
Themost appropriate medical treatments for the patient would be- passiverewarming with warming blankets as his body temperature is low,injecting cortisol or adrenal cortical hormone, injecting fluids,thyroid hormones applied through an IV or intravenously for rapidlycorrecting the low levels of thyroid hormone. However, usually Oralthyroid hormone will not be administered as he has serious myxedema,and it might take a very long time to reach the thyroid hormone levelwith this approach, and electrolytes replacement if needed.
Healthcare approach to the patient
The patient will be diagnosed in the following ways-
Blood tests will be done for checking thyroid hormone levels, bloodsugar, electrolytes, and blood cell counts. Additional tests will bedone for evaluating how the adrenal glands and liver are working.
Blood gases will be checked for checking the carbon dioxide andoxygen levels. And ECG or Electrocardiography will be done forchecking if there is any disturbance in the normal functioning of theheart. Additionally, more tests will be conducted as suggested by thehealthcare professionals (Wall, 2016).
Evaluation is important for confirming that the examination ofMyxedema coma is correct. Mathew et al. (2011) suggested that whenMyxedema coma is suspected, it is wise to start the treatment as soonas possible without looking for the test results to arrive.Confirming the patient’s test results can be done by the followingapproaches-
Thyroid function tests. These will be done to check for anythyroid disorder. Low levels of free T3 and T4 along with a normal orlow level of TSH might signal some sort of disorder and it can alsoshow that the syndrome is because of hypothalamic or pituitarydysfunction. Moreover, an evaluation of adrenal functions must bedone.
Comprehensive blood count. Sometimes leukocytosis cannot befound due to hypothermia. As a result, healthcare professionalssuggest that a white blood cell differential may be one of the fewclues to the presence of infection. So this test will also be donefor the patient.
According to Simmons (2010), Myxedema coma is a severe illness and itneeds instant treatment. So, this patient must be treated in an ICUwith constant monitoring of cardiac functions. The followinginterventions are needed for the patient-
Management of the Airway. Myxedema coma patients often sufferfrom depression or diminished mental abilities. This leads torespiratory failure. Consequently, automated ventilation will bemandatory for him for the first 2 days. However, if needed, it willbe continued for almost a month.
Replacement of thyroid hormone. At this point, ‘The AmericanThyroid Association’ advices a combination of therapy with T3 andT4 (Irwin & Rippe, 2012). Thyroid hormone therapy through theveins will be done due to the decreased gastrointestinal absorptionin the patient. A 50-100 micrograms of T4 (levothyroxine) through theveins every day is prescribed after an initial 300-600 microgramsdose.
Glucocorticoid therapy. Stress doses of glucocorticoids mustbe given through the veins until the likelihood of adrenal deficiencyis discounted by a random serum cortisol.
Other measures. Passive rewarming with warming blankets,treatment of other infections that are associated with thiscomplication, severe hyponatremia should be treated with plenty ofwater and saline, and hypoglycemia should be treated with dextroseinjections.
Peoplewith the history of ablation or resection for hyperthyroidism andpatients with previous Hashimoto thyroiditis are at the risk ofsuffering from Myxedema coma in the future (Mathew et al., 2011).Since this patient already has a history of hyperthyroidism, so hisTSH level must be checked every year. He and his relatives/caregiversmust be informed about the symptoms of Myxedema coma so that they cantake precautions and seek prompt medical attention once they see anyof the symptoms in him. During cold seasons, he should take extraprecautions, since cold elevates the risks of developing myxedemacrisis or coma. Finally, his hypothyroidism should be treatedadequately to reduce the risks of Myxedema coma.
Irwin, R. & Rippe, J. (2012). Irwinand Rippe`s intensive care medicine.Philadelphia: Wolters Kluwer Health/Lippincott Williams &Wilkins.
Mathew, V., Misgar, R., Ghosh, S.,Mukhopadhyay, P., Roychowdhury, P., & Pandit, K. et al. (2011).Myxedema Coma: A New Look into an Old Crisis. JournalOf Thyroid Research, 2011,1-7. http://dx.doi.org/10.4061/2011/493462
Nyström, E. (2011). Thyroiddisease in adults. Berlin: Springer.
Simmons, S. (2010). Myxedemacoma. Nursing, 40(6),72. http://dx.doi.org/10.1097/01.nurse.0000376307.36712.6a
Wall, C. (2016). MyxedemaComa: Diagnosis and Treatment. Aafp.org.Retrieved 24 July 2016, fromhttp://www.aafp.org/afp/2000/1201/p2485.html