Hypothermic Coma in Myxoedema

Angel, J. H.; Sash, Leonard

doi:10.1136/bmj.1.5189.1855

Cited by 33 publications

(5 citation statements)

References 16 publications

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“…In essence, reduced mobility from any condition predisposes for hypothermia. Hypothyroidism causes a slow metabolic rate and thus impairs the body's heat production, and hypothermia is a major component of myxedematous coma [81][82][83][84]. As glucose is one of the most important energy sources in the body, hypoglycemia (either as a result of food depletion or in diabetes) will result in an impaired heat production.…”

Section: Risk Factors For Hypothermiamentioning

confidence: 99%

Hypothermia

Türk

2010

Forensic Sci Med Pathol

135

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Hypothermia refers to a situation where there is a drop in body core temperature below 35 degrees C. It is a potentially fatal condition. In forensic medicine and pathology, cases of hypothermia often pose a special challenge to experts because of their complex nature, and the often absent or nonspecific nature of morphological findings. The scene of the incident may raise suspicions of a crime initially, due to phenomena such as terminal burrowing behavior and paradoxical undressing. An element of hypothermia often contributes to the cause of death in drug- and alcohol-related fatalities, in the homeless, in immersion deaths, in accidents and in cases of abuse or neglect, making the condition extremely relevant to forensic medical specialists. The aim of this review is to give an overview of the pathophysiological aspects of hypothermia and to illustrate different aspects relevant to forensic medical casework.

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Section: Risk Factors For Hypothermiamentioning

confidence: 99%

Hypothermia

Türk

2010

Forensic Sci Med Pathol

135

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“…rectally as a useful dividing‐line. It will be realized at once from Table I and the data of Angel and Sash (1960) that many cases of ‘hypothermic’ myxoedema coma have been reported which do not fulfil these criteria. It is indeed difficult to know where to draw a dividing‐line in considering these cases, because of the lack of uniformity in temperature‐recording and ‐reporting already mentioned.…”

Section: Discussionmentioning

confidence: 96%

“…The question of dosage is much debated. MacDonald (1958) and Angel and Sash (1960) advocate an initial dose which is proportional to the degree of hypothermia, subsequent doses being reduced as the body temperature rises towards normal, and then slowly increasing once more to the optimum dosage. Dyson and Wood (1956) used doses of 1,200 μg.…”

Section: Treatmentmentioning

confidence: 99%

Hypothermic Myxoedema Coma

Hyams

1963

Int J Clinical Practice

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“…In a study reported by Dutta et al, 15 of 23 patients presented in winter, and cold exposure was considered to be a major precipitating factor (9). In 1960, J.H Angel suggested that hypothermia itself maybe an indication for immediate treatment with a rapidly acting thyroid hormone (21).…”

Section: Discussionmentioning

confidence: 99%

Development of an Objective Tool for the Diagnosis of Myxedema Coma

Chiong

Bammerlin

Mariash

2011

TRANSLATIONAL - Iodine &Amp; Clinical Thyroid Disease

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Myxedema coma, a rare entity with a reported 25-65% mortality had no objective criteria for making the diagnosis when we began our study. We developed an objective screening tool for myxedema coma to more easily identify patients and examine the best treatment method in future prospective studies to reduce the mortality of this entity. We conducted a retrospective chart review to find all patients aged ≥ 18 years admitted with myxedema coma from 1/1/2005 through 6/13/2010 at Indiana University Health Methodist Hospital. Based both on our retrospective chart review and on literature-based accounts, we identified 6 criteria to diagnose myxedema coma. We identified 10 patients initially diagnosed with myxedema coma and established a control group consisting of 13 patients identified with altered mental status and elevated TSH levels. The six variables we created for the screening tool are heart rate, temperature, Glasgow coma scale, thyroid stimulating hormone, free T4, and precipitating factors. The screening tool has a sensitivity and specificity of about 80%. We ran a logistic regression model using the 10 study patients and 13 controls with the 6 variables. No variables alone significantly contributed to the model. However, the overall model was highly significant (P = 0.012), providing strong support for a scoring system that uses these variables simultaneously. This screening tool enables physicians to rapidly diagnose myxedema coma to expedite treatment. A more refined diagnostic tool may be used in future clinical studies designed to determine the optimal treatment.

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Hypothermic Coma in Myxoedema

Cited by 33 publications

References 16 publications

Hypothermia

Hypothermia

Hypothermic Myxoedema Coma

Development of an Objective Tool for the Diagnosis of Myxedema Coma

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