Template:Myasthenic vs cholinergic crisis
Revision as of 18:57, 13 September 2018 by Rossdonaldson1 (talk | contribs) (→Myasthenic versus cholinergic crisis)
Myasthenic versus cholinergic crisis
- Myasthenic Crisis
- Respiratory failure is feared complication
- Much more common
- Due to medication non-adherence, infection, surgery, tapering of immunosuppressants, meds
- Cholinergic Crisis
- Excessive anticholinesterase medication may cause weakness and cholinergic symptoms
- Rarely if ever seen with dose limitation of pyridostigmine to less than 120mg q3hr
- If on usual dose of meds assume exacerbation due to MG even with cholinergic side effects
- Edrophonium (Tensilon) test to distinguish the two is controversial
- Give 1-2mg IV slow push. If any fasciculations, respiratory depression, or cholinergic symptoms within a few minutes, problem is likely cholinergic crisis (no more edrophonium). If no evidence of cholinergic excess, give total of 10mg and observe improvement in case of myasthenic crisis.
- Side effects of Edrophonium: Arrhythmias, Hypotension, Bronchospasm
- Thus, need to be on a monitor, with atropine on hand
- Treatment: Atropine