Define myastehnic crisis.
acute, life-threatening exacerbation of myasthenic symptoms that leads to respiratory failure
Describe the epidemiology of myastehnic crisis.
Affects 15–20% of patients with MG
Most commonly occurs within 8–12 months after onset
Describe the etiology.
What is a DD?
Cholinergic crisis
What is the treatment?
IVIg
Plasmapheresis
Early endotracheal intubation
What is the cholinergic crisis?
potentially life-threatening acetylcholine receptor overstimulation
Describe the etiology of cholinergic crisis.
poisoning with organophosphates (e.g., parathion)
Describe the pathophysiology of cholinergic crisis.
irreversible acetylcholinesterase inhibition
Describe the epidemiology of cholinergic crisis.
most commonly seen in farmers, as organophosphates are used as insecticides
Describe the clinical presentation of cholinergic crisis.
Muscarinic effects
Excess of secretions, including salivation, sweating, lacrimation, urination, defecation, and emesis
Miosis and blurred vision
Bradycardia
Bronchospasm
Bronchorrhea
Nicotinic effects: blockage at the neuromuscular junction (similar mechanism observed in succinylcholine)
Systemic effects
Hypoventilation
Lethargy
Seizures, coma
Describe the treatment of cholinergic crisis.
antimuscarinic agents
Atropine
Pralidoxime
Upper vs lower motor neuron lesion.
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