> The internist believes her mental status was secondary to her
> hypoglycemia. I have never seen anyone with such prolonged
> mental depression following the correction of hypoglycemia
> and believe she was in myxedema coma, however I've never seen
> this either. Does anyone have any thoughts?
I've seen prolonged coma secondary to hypoglycaemia. Kind of like post
hypoxic coma. I tend to explain it by mumbling something along the lines of
'cerebral intracellular metabolites' and 'substrate depletion'. Anyway, it
happens, although I wouldn't expect it with only a 3 to 4 hour duration of
hypoglycaemia. I've seen myxedema come before, but it's pretty rare under
the age of 50, especially in the presence of normal vital signs (and
technically most people say you need the presence of myxedema to make the
diagnosis- otherwise it's 'hypothyroid coma', I think). I'm afraid I don't
know all the brand names of the drugs you prescribe (in the UK, often
different brand names and I tend to prescribe generically so don't know even
the UK brand names), but as a general rule, coma in newly/ previously un-
diagnosed hypothyroid patients is often due to consequences of
hypothyroidism rather than hypothyroidism itself. Reduced drug metabolism as
often as not- you mention benzos (is this the Xanax?). This could easily be
a cause. Treatment the same in any case- treat hypoglycaemia, supportive
care, aggressive treatment of hypothyroidism.
Good case.
Matt Dunn
Warwick
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