IS EVERY RESPIRATORY FAILURE A MYASTHENIC CRISIS?

Abstract: Myasthenic crisis is respiratory failure from myasthenic weakness. Due to the involvement of respiratory muscles, hypoventilation can occur and subsequently lead to hypoxia and hypercapnia. This paper presents a 82-year-old patient with a past medical history of myasthenia gravis who presented to the emergency department with complaints of asthenia and shortness of breath. Why should an emergency physician be aware of this: In patients presenting to a hospital due to shortness of breath, blood gas and D-dimer test results should be evaluated carefully. PE should be suspected in myasthenia gravis patients with hypocapnia and high D-dimer results. The patient was diagnosed with pulmonary embolism given the high value of D-dimer and hypocapnic blood gas.KEYWORDS: Myasthenic crisis, Pulmonary embolism, D-dimer, Arterial blood gase. HER SOLUNUM YETMEZLİĞİ MYASTENİK KRİZ Mİ?Özet: Myastenik kriz solunum kaslarında güçsüzlüğe bağlı solunum yetmezliği tablosudur. Solunum kaslarının etkilenmesi sonucu hipoksi ve hiperkapniye neden olan hipoventilasyon oluşur. Bu yazıda, myastenia gravis tanısı olan, 82 yaşında halsizlik ve nefes darlığı ile acil servise başvuran hasta sunuldu. Neden acil hekimi bunun farkında olmalı: Hastaneye nefes darlığı, nedeni ile başvuran hastalarda, kan gazı ve D-dimer test sonuçları dikkatle ele alınmalı. D-dimer yüksekliği ve hipokapni saptanan myastenia gravis hastalarında Pulmoner emboli akla getirilmelidir.ANAHTAR KELİMELER: Myastenik kriz, pulmoner emboli, D-dimer, Arter kan gazı

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  • Kirmani JF, Yahia AM, Qureshi Aİ., (2004). Myasthenic crisis. Curr Treat Options Neurology. 6(1):3-15.
  • Thomas JE, Mater SA, Gungor Y, Swarup R, Webster EA, Chang I., (1997). Myasthenic crisis: complications and risk factors for prolonged intubation. Neurology 48(5):1253-1260.
  • Putman MR, Wise RA., (1996). Myasthenia gravis and upper airway obstruction. Chest. 109(9):400-404.
  • Mayer SA., (1997). Intensive care of the myasthenic patient. Neurology.;48(5):70-75
  • Mehta S., (2006). Neuromuscular disease causing acute respiratory failure. Respir Care. 51(9):1016.
  • Sharshar T, Chevret S, Bourdain F, Raphaël JC, French., (2003). Early predictors of mechanical ventilation Cooperative Group on Plasma Exchange in Guillain-BarréSyndrome. Crit Care Med. 31(1):278
  • N, CarpenèN, Gherardi M., (2009). Chronic respiratory care for neuromuscular diseases in adults. Ambrosino Eur Respir J. 34(2):444.
  • Kyrle PA, Eichinger S., (2005). Deep vein thrombosis. Lancet 2005, 365:1163-1174
  • Anderson FA Jr, Spencer FA., (2003). Risk factors Circulaiton 2003;107 (23 Suppl.1):I9-16 thromboembolism.
  • http://www.ehealthme.com/Review: could Myasthenia gravis cause Fibrin d dimer increased?