Myxedema Coma

WHAT YOU SHOULD KNOW:

Myxedema Coma (Inpatient Care) Care Guide

  • Myxedema coma happens as a result of long-term, poorly controlled or untreated hypothyroidism. Hypothyroidism occurs when the thyroid gland makes too little or no thyroid hormone. The thyroid gland is a butterfly-shaped organ that is located in the front part of the neck. Thyroid hormones help control body functions such as heart rate, growth, body temperature, and weight gain or loss. With myxedema coma, the heart, lungs, brain, and other organs no longer work correctly. This condition may be caused by cold weather, surgery, certain medicines, or trauma, such as accidents, falls, or burns. Other causes include not taking thyroid medication as prescribed, having an infection, low blood sugar level, stroke, heart problem, or bleeding in the stomach.

  • With this condition, not all patients have myxedema (swelling of the skin) or fall into a coma. In addition to signs and symptoms of hypothyroidism, a patient may also have a very low temperature, problems thinking clearly, a slow and irregular heartbeat, or trouble breathing. Caregivers will ask about the patient's symptoms, other diseases and medicines, and do a physical exam. Blood and urine tests, chest x-ray, electrocardiogram (ECG) and a lumbar puncture may also be needed. Treatment will depend on the cause of the myxedema coma. Medicine may be given to bring thyroid hormone levels back to normal, decrease symptoms or treat the cause. The sooner that myxedema coma is treated, the better chance the patient has of returning to normal.

CARE AGREEMENT:

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

RISKS:

Myxedema coma is an emergency situation that may lead to deep coma and death. Early diagnosis and treatment are very important. Long-term problems with the heart, lungs or brain may occur if the condition is not treated as soon as possible. Ask caregivers for more information about hypothyroidism and how it may worsen to a coma. Talk to caregivers if you have any questions about the patient's condition, medicine, or care.

WHILE YOU ARE HERE:

Informed consent:

You have the right to understand your family member's or significant other's health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat her condition. Caregivers should also tell you about the risks and benefits of each treatment. Since your family member or significant other is unable to give consent, you may be given permission to sign a consent form for her. You may be asked to sign this form that gives caregivers permission to do certain tests, treatments, or procedures. A consent form is a legal piece of paper that tells exactly what will be done to the patient. Before giving your consent, make sure all of your questions have been answered so that you understand what may happen.

Intensive care unit:

The patient is placed in an intensive care unit (ICU). Caregivers will watch her very closely while she is in this special room. You and the patient's family or friends may be allowed to visit her in the ICU for a short visit several times a day.

Diet and nutrition:

A caregiver, called a dietitian, may talk to you, the patient, or her family members about feeding and nutrition. If the patient is awake and has no problems swallowing, she may be fed through the mouth or special tubes. A nasogastric tube is a tube put through the nose and down into the stomach. A tube may also go directly from the outside of the body into the stomach. This type of tube is called a gastrostomy tube. If the patient is in a coma, she may need total parenteral nutrition (TPN) through a large IV. These feedings supply protein, sugar, vitamins, minerals, and fat (lipids).

IV:

An IV is a tube placed in the patient's vein for giving medicine or liquids.

Medicines:

The patient may be given any of the following:

  • Antibiotics: Antibiotics help treat or prevent an infection caused by germs called bacteria.

  • Anticonvulsant medicine: This medicine is given to control seizures. Take this medicine exactly as directed.

  • Thyroid hormone: This medicine brings the thyroid hormone level back to normal.

  • Other medicines: Other medicines, such as steroids, may be given to treat adrenal problems causing weight loss, and severe weakness. Medicines may also be given to bring the blood pressure back to normal, or treat heart problems.

Monitoring:

  • Blood sugar checks: The patient's blood sugar may be checked many times each day. This is usually done before meals and at bedtime. Her finger is pricked to draw blood and the blood is put into a glucose monitor (glucometer). A glucometer is a small device that shows how much sugar is in the blood.

  • Heart monitor: The heart monitor helps caregivers look for problems with the way the heart is beating. Sticky pads are placed on the chest or different parts of the body. Each pad has a wire leading to a small portable box, or to a TV-type screen. This shows caregivers a tracing of the electrical activity of the heart. Do not remove any wires or sticky pads without asking her caregivers first.

  • Neurologic signs: Caregivers check the eyes, memory, hand grasp, and how easily the patient wakes up. These tests show caregivers how the brain is working after an injury or illness.

Tests:

  • Blood and urine tests: Blood tests check how body organs, such as the liver and kidneys, are working. A sample of urine may also be needed for tests. Blood and urine are checked for infection.

  • Chest x-ray: This is a picture of the lungs and heart. Caregivers may use the x-ray to look for signs of infection or fluid around the heart and lungs.

  • Electroencephalogram: This test is also called an EEG. Many small pads or metal discs are put on the patient's head. Each has a wire that is hooked to a machine. This machine prints a paper tracing of brain wave activity from different parts of the brain. Caregivers look at the tracing to see how the brain is working.

  • Lumbar puncture: In this test, fluid is removed from around the spinal cord using a thin needle. The fluid is sent to a lab for tests. This test checks for infection, bleeding around the brain and spinal cord, or other problems.

Treatment options:

  • Oxygen: Extra oxygen may be needed to help your family member or significant other breathe easier. It may be given through a plastic mask over the mouth and nose, a nasal cannula, or prongs. A nasal cannula is a pair of short, thin tubes that rest just inside the nose. Ask caregivers before taking off the oxygen. Never smoke or let anyone else smoke in the same room while the oxygen is on. Doing so may cause a fire.

  • Ventilator: A ventilator is a special machine that can breathe for a person if they cannot breathe well on their own. The patient may have an endotracheal (ET) tube in her mouth or nose. A tube called a trach may go into an incision (cut) in the front of her neck. The ET tube or trach is hooked to the ventilator.

  • What a family member or significant other can do to help with care: A family member or significant other may be able to help with positioning, range of motion exercises, skin care, and bowel and bladder care. Ask the patient's caregiver to show you ways that you can help with care.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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.

Learn more about Myxedema Coma (Inpatient Care)

Hide
(web1)