MYXEDEMA COMA: WAKE ME WHEN 2020 ENDS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Myxedema coma is a rare, life-threatening medical emergency with mortality rate of 30-60% [1]. Symptoms include altered mental status, hyponatremia, hypothermia, hypotension, bradycardia, and hyperventilation. Treatment may supportive mechanical ventilation vasopressors in addition to thyroid hormone replacement We present patient myxedema secondary medication non-compliance. CASE PRESENTATION: A 41-year-old woman history hypothyroidism neurofibromatosis type 1 presented the department after being found unresponsive at home. Documentation from previous outpatient visits suggested non-compliance therapy. Her vitals were significant for systolic blood pressure 60 mmHg, heart 55 beats per minute, temperature 82.6°F. She was intubated airway protection admitted intensive care unit, where she started on warm intravenous fluids. Laboratory values included Na 129 mmol/L. Arterial gas showed pH 7.64 pCO2 18.6 mmHg. TSH 62.5 mU/L, Free T3 0.76 pg/mL, T4 <0.07 ng/dL. promptly treated hydrocortisone levothyroxine her condition stabilized rapidly; however, encephalopathy persisted required tracheostomy, percutaneous endoscopic gastrostomy, discharge skilled nursing facility. In follow-up two months later it documented that had made full recovery tracheostomy gastrostomy tubes removed. DISCUSSION: developed countries modern era, untreated rarely progresses due widespread availability levothyroxine. Medication most common etiology this setting. Of note, autoimmune disease associated (NF1). It theorized loss function neurofibromin leads uncontrolled cell growth prevention apoptosis CD4+ T cells, which turn contributes development autoimmunity[2]. CONCLUSIONS: This case highlights morbidity coma, as demonstrated by prolonged leading decreased ventilator-free days increased ICU length stay, well requirement placement facility discharge. Despite its rarity (with an estimated incidence 0.22 1,000,000 year[3]), high rates mandate clinical suspicion prompt recognition management critical providers. Suspicion should be raised when presents status. case, diagnosis timely initiation treatment resulted favorable outcome. REFERENCE #1: Kwaku MP, Burman KD. coma. J Intensive Med 2007; 22:224-31. #2: Güler S, Yeşil G, Önal H. Endocrinological evaluations cohort: necessary evaluate thyroiditis 1? Balkan J. 2017;34:522–6. #3: Rodríguez I, Fluiters E, Pérez-Méndez LF, et al. Factors patients myxoedema coma: prospective study 11 cases single institution. The Journal Endocrinology. 2004 Feb;180(2):347-350. DISCLOSURES: No relevant relationships Jonathan Burgei, source=Web Response Ashley Desmett, Frederick Qubti,