Template:Myasthenic vs cholinergic crisis: Difference between revisions
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Revision as of 18:56, 13 September 2018
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