The myasthenia gravis crisis with titration therapy guided by blood gas monitoring: a case report

Abstract

Myasthenia gravis (MG) is an autoimmune disease characterized by postsynaptic membrane dysfunction at the neuromuscular junction. It is characterized by muscle fatigue and weakness, and its main antigen target is acetylcholine receptor (AChR). When respiratory failure caused by involved respiratory muscles such as the diaphragm requires invasive or non-invasive ventilation, it is called myasthenia crisis (MC). Inadequate ventilation can lead to massive retention of CO2, elevated PCO2 and increased intracranial pressure, which lead to disturbance of consciousness. Therefore, it is particularly important to monitor dynamic blood gas in time and take accurate treatment. The purpose of titration anticholinesterase treatment is to provide an appropriate dose for drug conversion, to deal with the “end-of-dose of drug phenomenon” well, and to provide better weaning conditions for crisis patients after their respiratory function have taken a turn for the better. This article reported a case of MC patient with positive anti-AChR antibody who suffered from the dysphagia, the dyspnea, and disturbance of consciousness caused by infection. After dynamically monitoring of blood gas analysis, mechanical ventilation, controlling infection and titration of anti-cholinesterase drugs were given, the patient had improved and discharged.

Keywords

• myasthenia gravis
• myasthenic crisis
• arterial blood gas analysis
• titration therapy