고암모늄혈증이 동반된 점액수종 혼수 1례

Abstract

Myxedema coma is a rare syndrome that represents the extreme expression of hypothyroidism. Myxedema coma and hepatic encephalopathy coma share some clinical features: coma, ascites, anemia and elevated liver functions. Not only hepatic encephalopathy but also myxedema coma has hyperammonemia. In patients with an elevated ammonia level, altered mental status, and liver disease, who do not respond to appropriate therapy for hepatic encephalopathy, myxedema coma should be considered and evaluated. When myxedema coma is diagnosed by signs and symptoms, the rapid administration of medication is needed. But thyroid hormone replacement therapy can cause cardiovascular emergency, and must be used with caution. We report a case of myxedema coma combined with hyperammonemia that was misdiagnosed hepatic encephalopathy and unresponsive to conventional therapy. Thyroid hormone replacement resulted in gain of consciousness and normalization of hyperammonemia. But we experienced side effect, especially ventricular tachycardia.