Treatment of myasthenic crises:
1. The first step is to ensure adequate breathing with forced Artificial ventilation. Indications for mechanical ventilation are respiratory rhythm disturbance, cyanosis, agitation, loss of consciousness, part of the auxiliary muscles, the change in the pupils, the lack of response to the introduction of anticholinesterase drugs.
2. Conduct or plasmapheresis or plazmasorbtsii. Conducted a course for 1-2 weeks with a multiplicity of 2-5 operations.
3. The use of immunoglobulins. The human Ig is an immunoreactive protein. Drugs are extracted from the plasma of healthy people. High doses Ig suppress immune processes. Currently Ig therapy is an alternative to plasmapheresis, due to similarities of mechanisms underlying these treatments.
The generally accepted mode of treatment is considered a short 5th-day courses of intravenous administration of 400 mg / kg daily. On average, the clinical effect observed on the 4th-day of therapy and lasts for 50-100 days. Can also be used intravenously and Octagam and Biovit in the minimum dose 4-5 mg/kg, the total dose is 25g.
You can use normal human Ig at a dose of 50 ml intravenously drip at 100-150 ml of saline. Infusion repeated every other day at a dose of 3-5 g per treatment.
4. The use of anticholinesterase drugs, mostly parenteral. Use anticholinesterase drugs as a diagnostic tests are shown in any form of crisis (most effectively to their introduction in myasthenic crisis). Neostigmine injected s/c in a dose of 1.5 to 2.5 ml, to reduce the adverse effects of atropine 0.2-0.5 ml 0.1% solution. The result is estimated as at prozerin test.
5. Prescribing of glucocorticosteroid medications. The most effective pulse therapy of methylprednisolone intravenously at a dose of 1000 mg. After the pulse therapy is recommended daily dose of prednisolone.
1. First aid: a guide for doctors under the general editorship prof. Vladimir Nikonov. Electronic version: Kharkov, 2007. Prepared by the Department of Medicine of emergency conditions, disaster medicine and military medicine KhMAPE