Myxedema coma in patients with SARS-COV-2. Literature Review
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Publicación 4. Vol 6. Num 4 (Español (España))
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Published:
Oct 5, 2023
Keywords:
Mixedema coma, Levothyroxine, Endocrine emergency, Hypothyroidism, SARS-COV-2
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Abstract
Introduction: Coma mixedematoso represents the extreme manifestation of uncontrolled hypothyroidism, which can occur in patients who are experiencing a systemic illness such as SARS-COV-2, leading to increased patient mortality due to the fatal interaction between these two conditions when they coexist. Objective: To provide an updated overview of the diagnosis and management of coma mixedematoso in patients with SARS-COV-2. Methodology: A conceptual literature review on coma mixedematoso in SARS-COV-2 patients was conducted, extracting information from various scientific databases such as PubMed, Scielo, Science Direct, among others, using the PRISMA strategy. Results: In patients with SARS-COV-2 and coma mixedematoso, notable vital signs include bradycardia, hypotension, eutermia, and low oxygen saturation. This may result from the interaction between both conditions. Coma mixedematoso can be directly or indirectly triggered by the infection, especially in intensive care patients with respiratory distress syndrome. Therefore, evaluating thyroid function in SARS-COV-2 patients, particularly in severe cases, is crucial. Conclusion: Thyroid profile assessment should be considered in SARS-COV-2-infected patients due to the possibility of developing coma mixedematoso. This diagnosis should be considered in cases of altered consciousness with normal or low body temperature, even during an infection. In these patients, the prevalence of coma mixedematoso is higher in women (90% in analyzed cases), and the relationship between respiratory rate and oxygen saturation is not always inversely proportional. Hypotension is common (72.73%) and is often associated with a decrease in pulse pressure due to negative inotropic and chronotropic effects and vasoconstriction. General Study Area: Medicine Specific Study Area: General Medicine
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Martínez Gómez, K. O., & Calvo Campoverde, E. G. (2023). Myxedema coma in patients with SARS-COV-2. Literature Review. ConcienciaDigital, 6(4), 112-144. https://doi.org/10.33262/concienciadigital.v6i4.2698
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References
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Bellafante, D., Gioia, S., Faccioli, J., Riggio, O., Ridola, L., & Nardelli, S. (2023). Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution. Journal of Clinical Medicine, 12(3), 1187.
Butterworth, R. F. (2019). Hepatic Encephalopathy in Cirrhosis: Pathology and Pathophysiology. Drugs, 79(Suppl 1), 17-21.
Coronel-Castillo, C. E., Contreras-Carmona, J., Frati-Munari, A. C., Uribe, M., & Méndez-Sánchez, N. (2020). Efficacy of rifaximin in the different clinical scenarios of hepatic encephalopathy. Revista de Gastroenterología de México, 85(1), 56-68.
Di Marco, L., La Mantia, C., & Di Marco, V. (2022). Hepatitis C: Standard of Treatment and What to Do for Global Elimination. Viruses, 14(3), 505.
Enomoto, H., Ueno, Y., Hiasa, Y., Nishikawa, H., Hige, S., Takikawa, Y., ... & Nishiguchi, S. (2020). Transition in the etiology of liver cirrhosis in Japan: a nationwide survey. Journal of Gastroenterology, 55(3), 353-362.
Faccioli, J., Nardelli, S., Gioia, S., Riggio, O., & Ridola, L. (2022). Minimal Hepatic Encephalopathy Affects Daily Life of Cirrhotic Patients: A Viewpoint on Clinical Consequences and Therapeutic Opportunities. *Journal of Clinical Medicine*, 11(23), 7246.
González-Regueiro, J. A., Higuera-de la Tijera, M. F., Moreno-Alcántar, R., & Torre, A. (2019). Fisiopatología y opciones de tratamiento a futuro en la encefalopatía hepática. Revista de Gastroenterología de México, 84(2), 195-203.
Green, E. W., & Mitra, A. (2022). Diagnosis and management of hepatic encephalopathy: A summary for patients. *Clinical Liver Disease*, 20(3), 90-92.
Grgurevic, I., Podrug, K., Mikolasevic, I., Kukla, M., Madir, A., & Tsochatzis, E. A. (2020). Natural History of Nonalcoholic Fatty Liver Disease: Implications for Clinical Practice and an Individualized Approach. *Canadian Journal of Gastroenterology and Hepatology*, 2020, e9181368.
Gu, W., Hortlik, H., Erasmus, H. P., Schaaf, L., Zeleke, Y., Uschner, F. E., ... & Más autores. (2022). Trends and the course of liver cirrhosis and its complications in Germany: Nationwide population-based study (2005 to 2018).
Hepatic Encephalopathy: Definition, Pathogenesis, Clinical Features of Hepatic Encephalopathy. (2023, June 30). [Citado el 7 de julio de 2023]. Disponible en:
Huang, D. Q., Terrault, N. A., Tacke, F., Gluud, L. L., Arrese, M., Bugianesi, E., ... & Más autores. (2023). Global epidemiology of cirrhosis — aetiology, trends, and predictions. Nat Rev Gastroenterol Hepatol, 1-11.
Inmunoprvenibles-SE-38.pdf.
Jalan, R., & Rose, C. F. (2022). Heretical thoughts into hepatic encephalopathy. Journal of Hepatology, 77(2), 539-548.
Kasper, P., Tacke, F., & Michels, G. (2022). [Management of acutely decompensated liver cirrhosis in emergency and critical care medicine]. *Medizinische Klinik - Intensivmedizin und Notfallmedizin*, 117(1), 73-82.
Li, B., Zhang, C., & Zhan, Y. T. (2018). Nonalcoholic Fatty Liver Disease Cirrhosis: A Review of Its Epidemiology, Risk Factors, Clinical Presentation, Diagnosis, Management, and Prognosis. *Canadian Journal of Gastroenterology and Hepatology*, 2018, e2784537.
Luo, M., Ma, P., Li, L., & Cao, W. K. (2019). Advances in psychometric tests for screening minimal hepatic encephalopathy: From paper-and-pencil to computer-aided assessment. Turkish Journal of Gastroenterology: The Official Journal of Turkish Society of Gastroenterology, 30(5), 398-407.
Luo, M., Yu, X. B., Hu, S. J., & Bai, F. H. (2020). EncephalApp Stroop App predicts poor sleep quality in patients with minimal hepatic encephalopathy due to hepatitis B-induced liver cirrhosis. Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association, 26(3), 120-128.
Moctezuma-Velazquez, C., Castro-Narro, G., Simó, P., Viayna, E., Aceituno, S., Soler, M., ... & Belaiche, J. (2022). Economic evaluation of long-term albumin uses in cirrhosis patients from the Mexican healthcare system perspective. *Annals of Hepatology*, 27(2), 100673.
Pawar, V. B., Surude, R. G., Sonthalia, N., Zanwar, V., Jain, S., Contractor, Q., ... & Mishra, S. (2019). Minimal Hepatic Encephalopathy in Indians: Psychometric Hepatic Encephalopathy Score and Inhibitory Control Test for Diagnosis and Rifaximin or Lactulose for Its Reversal. Journal of Clinical and Translational Hepatology, 7(4), 304-312.
Perez, I. C., Bolte, F. J., Bigelow, W., Dickson, Z., & Shah, N. L. (2021). Step by Step: Managing the Complications of Cirrhosis. Hepatic Medicine: Evidence and Research, 13, 45-57.
Principales resultados de la Encuesta Nacional de Salud y Nutrición 2020 (2021, junio 10).
Puentes, J. C. P., Rocha, H., Nicolau, S., & Ferrão, G. (2018). Effectiveness of the MELD/Na Score and the Child–Pugh Score for the Identification of Palliative Care Needs in Patients with Cirrhosis of the Liver. Indian Journal of Palliative Care, 24(4), 526-528.
Rivera-Flores, R., Morán-Villota, S., Cervantes-Barragán, L., López-Macias, C., & Uribe, M. (2020). Manipulation of microbiota with probiotics as an alternative for treatment of hepatic encephalopathy. Nutrition, 73, 110693.
Shahgond, L., Patel, C., Thakur, K., Sarkar, D., Acharya, S., & Patel, P. (2022). Therapeutic potential of probiotics – Lactobacillus plantarum UBLP40 and Bacillus clausii UBBC07 on thioacetamide-induced acute hepatic encephalopathy in rats. Metabolic Brain Disease, 37(1), 185-195.
Tapper, E. B., Henderson, J. B., Parikh, N. D., Ioannou, G. N., & Lok, A. S. (2019). Incidence of and Risk Factors for Hepatic Encephalopathy in a Population-Based Cohort of Americans with Cirrhosis. Hepatology Communications, 3(11), 1510-1519.
Thanapirom, K., Wongwandee, M., Suksawatamnuay, S., Thaimai, P., Siripon, N., Makhasen, W., ... & Poovorawan, Y. (2023). Psychometric Hepatic Encephalopathy Score for the Diagnosis of Minimal Hepatic Encephalopathy in Thai Cirrhotic Patients. Journal of Clinical Medicine, 12(2), 519.
Torres, D. S., Abrantes, J., & Brandão-Mello, C. E. (2020). Cognitive and neurophysiological assessment of patients with minimal hepatic encephalopathy in Brazil. *Scientific Reports*, 10(1), 8610.
Trebicka, J., Fernandez, J., Papp, M., Caraceni, P., Laleman, W., Gambino, C., ... & Angeli, P. (2020). The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology. *Journal of Hepatology*, 73(4), 842-854.
Trebicka, J., Fernandez, J., Papp, M., Caraceni, P., Laleman, W., Gambino, C., ... & Más autores. (2020). The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology. J Hepatol, 73(4), 842-854.
Velarde-Ruiz Velasco, J. A., García-Jiménez, E. S., Aldana-Ledesma, J. M., Tapia-Calderón, D. K., Tornel-Avelar, A. I., Lazcano-Becerra, M., ... & Más autores. (2022). Evaluación y manejo de emergencias en el paciente con cirrosis. Rev Gastroenterol México, 87(2), 198-215.
Voicu, D. F., Anghel, L., Baroiu, L., & Stan, D. (2020). About Minimal Hepatic Encephalopathy. BRAIN Broad Research in Artificial Intelligence and Neuroscience, 11(1Sup1), 70-77.
Wang, M. W., Ma, W. J., Wang, Y., Ma, X. H., Xue, Y. F., Guan, J., ... & Ren, Z. F. (2023). Comparison of the effects of probiotics, rifaximin, and lactulose in the treatment of minimal hepatic encephalopathy and gut microbiota. Frontiers in Microbiology, 14, 1091167.
Woodhouse, C. A., Patel, V. C., Singanayagam, A., & Shawcross, D. L. (2018). Review article: the gut microbiome as a therapeutic target in the pathogenesis and treatment of chronic liver disease. Alimentary Pharmacology & Therapeutics, 47(2), 192-202.
Xia, X., Chen, J., Xia, J., Wang, B., Liu, H., Yang, L., ... & Xie, Y. (2018). Role of probiotics in the treatment of minimal hepatic encephalopathy in patients with HBV-induced liver cirrhosis. Journal of International Medical Research, 46(9), 3596-3604.
Xu, X. Y., Ding, H. G., Li, W. G., Jia, J. D., Wei, L., Duan, Z. P., ... & Shang, J. Y. (2019). Chinese guidelines on management of hepatic encephalopathy in cirrhosis. World Journal of Gastroenterology, 25(36), 5403-5422.
Yeverino-Gutiérrez, M. L., González-González, M. del R., & González-Santiago, O. (2020). Mortality From Alcohol-Related Liver Cirrhosis in Mexico (2000–2017). *Frontiers in Public Health*, 8. https://www.frontiersin.org/articles/10.3389/fpubh.2020.524356