Page 234 - Critical Care Notes

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ENDO
■ Administer demeclocycline (Declomycin, Declostatin, Ledermycin) to treat
hyponatremia by inhibiting the action of ADH.
■ Administer vasopressin-2 receptor antagonists such as conivaptan (Vaprisol)
or tolvaptan (Samsca) to treat hyponatremia.
■ Institute seizure and safety precautions
■ Radiation or chemotherapy may be administered to reduce tumor progres-
sion, with resulting normal ADH production.

Myxedema Coma or Crisis
Myxedema coma is a form of severe hypothyroidism. It is usually precipitated by
a secondary condition such as infection, a systemic disease, or select medications.
Pathophysiology
Hypothyroidism → ↓ metabolic rate, ↓ O 2 consumption → peripheral vasocon-
striction → diastolic hypertension and ↓ blood volume.
Clinical Presentation
■ Fatigue
■ Hypothermia and cold intolerance; absence of shivering
■ Absence of fever in the presence of infection
■ Abdominal distention, decreased bowel sounds, constipation
■ Dry skin, cold extremities
■ Periorbital edema; sacral or peripheral edema
■ Normal systolic BP, elevated diastolic BP, slow heart rate, depressed
respirations
■ Hypotension, shock
■ Lethargy, confusion, paranoia, stupor, delirium
■ Seizures, coma
Diagnostic Tests
■ Serum thyroid tests
■ Serum cortisol level
■ Serum electrolytes and chemistries including BUN and creatinine
■ Serum osmolarity
■ CBC
■ Creatine kinase (CK) levels to rule out MI
■ ABGs
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