Consumer Information

Myasthenic Crisis

GENERAL INFORMATION:

What is a myasthenic crisis?

Myasthenic crisis (MC) is a life-threatening condition where the muscles you use for breathing become very weak. Myasthenic crisis is also called myasthenic gravis crisis. Weakened breathing muscles may cause severe breathing problems and lead to lung failure. Normally, impulses (signals) from your brain travel down through your nerves. Nerve endings release a chemical called acetylcholine that lets your nerves move your muscles when needed. MC is the worst form of myasthenia gravis (MG). MG causes your body to make antibodies (body substance) that attack and destroy the receptors in your muscles. Receptors are special structures in your muscles that take in acetylcholine. When the receptors are blocked, acetylcholine cannot enter the muscle cells.
In MC, the muscles used during breathing and swallowing are weak and do not function properly. When this happens, you may have trouble breathing. You may need a breathing machine to help you breathe and live. MC is an emergency condition and you may die if it is not treated right away. Treating MC may make your muscles stronger so you can breathe better. Treatment may prevent your lungs from failing.

What factors may trigger or increase my risk for myasthenic crisis? Myasthenic crisis may occur for no known reason. Anything that worsens your myasthenia gravis may lead to MC. Any of the following may trigger or increase your risk for MC:

Medical conditions: Ask your caregiver for more information about the following conditions:
- Aspiration pneumonitis: When a liquid or object is inhaled into your lungs, it is called aspiration. Aspiration commonly happens if you breathe in stomach acid or vomit. This causes your lung tissues to swell and may lead to MC.
- Fever: High body temperature.
- Infections: Lung infections such as pneumonia may trigger MC. Infections are caused by germs called viruses or bacteria. The infection may spread to your blood, causing sepsis. Sepsis may also trigger MC. Simple coughs or colds also increase your risk for MC.
- Thymoma: This is a tumor (growth) found in your thymus gland. The thymus gland is a part of your immune system that helps fight infection. The thymus is found in your chest near your heart.
- Thyroid disease: The thyroid gland is a small, butterfly-shaped organ in the front of your neck. It makes hormones (special chemicals) that help control how your body works. Problems with your thyroid gland may lead to MC.
Medicines:
- A sudden change in the amount of certain medicines you take may lead to MC. Some medicines that are used to treat your MG may also trigger the condition. These include anticholinesterase, antibiotics, blood pressure medicine, or steroid medicines. Anticholinesterase is medicine that increases the amount of acetylcholine in your muscles. Taking this medicine when you have MG helps your muscles get stronger. MC may occur when you have taken too much of this medicine or if you stop taking it.
- Magnesium and medicines to treat thyroid problems may lead to MC. Medicines to help treat mental conditions may also increase your risk. Ask your caregiver for more information about these and other medicines that may trigger MC.
Menstruation and pregnancy: Women's menstrual periods may worsen their myasthenia gravis and lead to crisis. Women who have just given birth are also at an increased risk.
Stress: Anything that causes stress to your body may trigger a crisis. Trauma, recent surgery, or emotions such as being very upset may increase your risk of having MC.
Use of contrast dyes: Some imaging tests may need to use dye to help the pictures show up better. Certain dyes may trigger MC. Ask your caregiver for more information about dyes that can cause MC.

What are the signs and symptoms of a myasthenic crisis? Your symptoms of myasthenia gravis may worsen during a myasthenic crisis. You may also have any of the following:

Feeling like you are not getting enough air. You may have very fast and shallow breathing, or noisy breathing.
Pulling in of the skin between your ribs, around your neck, or abdomen (stomach) with each breath.
Shortness of breath (unable to count to 20 during a single breath) and sweating.
Speech problems or a wet gurgling voice.
Morning headaches, or feeling tired during the daytime.
Waking up often while you are asleep or feeling like you did not get a good night sleep.
Weak cough with increased secretions (phlegm or spit) or an inability to clear secretions.
Weak tongue, trouble swallowing or chewing, and weight loss.

How is a myasthenic crisis diagnosed? If you have myasthenia gravis and are having trouble breathing, MC will be strongly suspected. You may need any of the following:

Blood gases: This test is also called an arterial blood gas or ABG test. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. The groin is the area where your abdomen meets your upper leg. Your blood is tested for the amount of "gases" in it, such as oxygen, acids, and carbon dioxide.
Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
Imaging tests: Imaging tests are done to take pictures of certain areas of your body. Some imaging tests use a special dye to help the pictures show up better. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your caregiver if you are allergic to shellfish, or have other allergies.
- Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia. Chest x-rays may also show fluid around your heart and lungs.
- Computed tomography scan: This is also called a CT scan. A special x-ray machine uses a computer to take pictures of your chest. This is used to check your lungs, heart, and blood vessels. It is also used to check if you have a thymoma.
- Magnetic resonance imaging: This test is also called an MRI. During the MRI, pictures are taken of your chest. An MRI may be used to look at your lungs and heart. It may also be used to check for a thymoma. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury.
Pulmonary function tests: Pulmonary function tests, also called PFTs, help caregivers learn how well your lungs work. PFTs may also help your caregivers decide on the best treatment for you. During the tests, you breathe into a mouthpiece connected to a machine. The machine measures how much air you breathe in and out over a certain amount of time. This helps caregivers to see how well your lungs are moving and working.

How is a myasthenic crisis treated? MC is an emergency condition that needs to be treated quickly. Your caregiver will work to keep your breathing and blood pressure stable. You may need to stay in a special area of a hospital where you will be watched carefully for problems. You may need one or more of the following:

Breathing support: Ask your caregiver for more information about the following:
- Endotracheal tube: An endotracheal (ET) tube may be put into your mouth or nose. The ET tube goes into your windpipe to keep your airway open. It may be attached to a ventilator which is a machine that helps you breathe, and you may get extra oxygen through your ET tube. You will not be able to talk while the ET tube is in place.
- Bilevel positive airway pressure: Bilevel positive airway pressure (BiPAP) is a device that helps you breathe easier. BiPAP is also called non-invasive ventilation because oxygen can be given without using a tube in your throat.
- Suctioning: You may have secretions that need to be suctioned out of your airway. If you have muscle weakness from your MC, you may have a hard time coughing out your secretions. Removing secretions may help you breathe easier. You may need suctioning with or without an ET tube in place.
Medicines: You may need to stop medicines you are taking if they have caused your MC. You may be given any of the following:
- Anticholinesterase medicine: Anticholinesterase is medicine that increases the amount of acetylcholine in your muscles. Acetylcholine is a special body chemical that helps your muscles and nerves communicate (talk to each other) better. It helps you get stronger. You may also take this medicine with steroids. Do not stop taking these medicines without your caregivers OK.
- Immune globulins: Immune globulins can be used to treat many different problems. It may be given to help your immune system fight infection. It may also help if your body does not produce enough of certain kinds of blood cells. This medicine may help if your system fights something in your blood or body that it should not. Ask your caregiver for more information about how immune globulin medicine may help you.
- Immunosuppressive therapy: These medicines may be given to decrease muscle weakness and slow down your immune system. The immune system protects your body from infections and diseases. The immune system may see normal cells as abnormal. These medicines may prevent your immune system from causing symptoms of MC.
- Supplements: Certain medicines used to treat MC may cause your bones to weaken. Your caregiver may give you vitamin D and calcium to help prevent bone loss and fractures. Ask your caregiver for more information about these supplements.
Intravenous fluids: Intravenous (IV) fluids may be given to prevent your blood pressure from becoming too low. IV fluids may also help replace any lost fluids and electrolytes (salts) from your body. Conditions such as a fever may cause you to lose fluids from your body.
Plasma exchange: This removes plasma (fluid portion) from your blood, and replaces it with plasma from a donor (another person). Liquid saline may also be used to replace your plasma. An IV tube is put in your vein and some of your blood is removed. A special machine spins and separates the plasma from the blood cells. Your plasma is then taken out and replaced by donor plasma or saline. The blood cells, and replacement plasma or saline are then put back in your body through an IV. Ask your caregiver for more information about plasma exchange.

When should I call my caregiver? Call your caregiver if:

You have loose bowel movements, feel like throwing up, or have stomach upset after taking your medicine.
You have a fever, cough, or a cold.
You have morning headaches.
You miss taking any of your medicines used to treat your MG.
You have questions about your condition, medicine, or care.

When should I seek immediate help? Seek care immediately or call 911 if:

You suddenly have trouble breathing or swallowing.
You suddenly have trouble talking.
Your symptoms of muscle weakness worsen even after taking your medicines.

Where can I find support and more information? You and your family may have a hard time coping with your condition. You and those close to you may feel angry, depressed, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. You may also want to join a support group. This is a group of people who have survived a myasthenic crisis. Contact `the following:

Myasthenia Gravis Foundation of America
1821 University Ave W, Ste 5256
St. Paul, MN 55104
Phone: 1-651-917-6256
Phone: 1-800-541-5454
Web Address: http://www.myasthenia.org

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Link to Page

Print Page

Email Page

	Search:
Browse all medications A B C D E F G H I J K L M N O P Q R S T U V W X Y Z	Advanced Search