Metabolic changes

Hyponatremia is a constant feature of myxedema coma. It is a dilution hyponatremia, with high radiosodium space, which is reversible after restriction of water intake

(Byrgiand König.1988). Indeed, the ability of hypothyroid kidneys to excrete water is more impaired than their ability to excrete sodium. This is mainly explained by the reduction in glomerular filtration rate, leading to a decreased delivery of sodium to the thick ascending limb of Henle where free water is formed ( BüroLand König... 1988). Furthermore, inappropriately high plasma levels of vasopressin are usually present, leading to water retention. Reduction of glomerular filtration is explained by a decreased renal blood flow secondary to reduction of cardiac output and increased vascular resistance favored by thickening of the basement membrane of the vessels (B.ü[gj.,§ndKöDi.g 1988). Acid-base metabolism is disturbed in myxedema coma with respiratory acidosis.

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