Myxedema Coma and Hypothyroidism

2. Diagnosis: Myxedema Coma

3. Condition:

4. Vital signs: q1h. Call physician if BP systolic >160/90, <90/60; P >130, <50; R>25, <10; T >38.5°C

5. Activity: Bed rest

6. Nursing: Triple blankets prn temp <36°C, inputs and outputs, aspiration precautions.

9. Special Medications: Myxedema Coma and Hypothyroidism:

-Volume replacement with NS 1-2 L rapid IV, then 125 mL/h. -Levothyroxine (Synthroid, Levoxine) 300-500 mcg IV, then 100 mcg PO or IV qd.

-Hydrocortisone 100 mg IV loading dose, then 50-100 mg IV q8h. Hypothyroidism in Medically Stable Patient:

-Levothyroxine (Synthroid, T4) 50-75 mcg PO qd, increase by 25 mcg PO qd at 2-4 week intervals, to 75-150 mcg qd until TSH normalized.

11. Extras: ECG, endocrine consult.

12. Labs: CBC, SMA 7&12; sensitive TSH, free T4. UA, RA factor, ANA.

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