Hypothermia with loss of consciousness and hyponatraemia

Abstract

I M derness. Laboratory data revealed hyponatraemia (sodium 125 mEq/l) with normal renal function (creatinine, 1.1 mg/dl), normal blood glucose (87 mg/dl) and hypercholesterolaemia (total cholesterol, 252 mg/dl). Myxoedema coma was then suspected and the patient was promptly treated with L-thyroxine (via nasogastric tube) and intravenous methyl-prednisolone. Consciousness and valid circulation recovered within 24 h.Magnetic resonance imaging (MRI) showed an empty sella turcica (Fig. 1). Hormonal panel confirmed the clinical hypothesis of a hypopituitarism: ACTH<5 pg/ml, TSH 0.78 µU/ml, FSH 1 mU/ml, LH 0.2 mU/ml, PRL 3.6 ng/ml, ADH Intern Emerg Med (2007) 2:113-115 A 75-year-old man was admitted to the surgical unit complaining of severe constipation, diffuse abdominal pain and vomiting. In his past medical history, there was only a peptic duodenal ulcer. Abdominal X-ray showed bullation of colonic frame, presence of multiple hydropneumatic levels, and dilation of the colon until the ampulla. Colonoscopy showed a marked hypertonia of the anal sphincter with hypertrophy of anal papillae. Evacuation was obtained by means of rectal tube. However the consciousness levels gradually decreased until the onset of a comatose state so that the patient was urgently transferred to our department. On arrival, his Glasgow Coma Scale was 7, with hypothermia (33.9°C; 89.02°F), hypotension (90/40 mmHg) and bradycardia (42 beats/min). No other findings were notable at physical examination for heart murmur, pulmonary noise or abdominal tenFig. 1 MRI: sagittal (upper half) and coronal (lower half) T1-weighted scans show an empty sella turcica

Myxedema Coma as Initial Clinical Presentation of Empty Sella Syndrome

“…Treatment of myxedema coma includes intravenous levothyroxine, concurrent therapy with hydrocortisone in view of impaired adrenal reserve and treatment of precipitating illness. Common complications include dilutional hyponatremia, circulatory collapse and respiratory failure [14].…”