Myasthenic crisis

New myasthenics may present in crisis and treatment should be started with steroids, azathioprine and pyridostigmine. Plasma exchange may be useful to reduce the antibody load. In known myasthenics an increased dose of pyridostigmine and steroids will be required. If the condition deteriorates drug therapy should be stopped; plasma exchange may be life saving. Anticholinesterases may produce improvement in some muscle groups and cholinergic deterioration in others due to differential sensitivity. As with any case of acute weakness mechanical ventilatory support is required if FVC <1l or the PaCO2 is raised.

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