Anaesthetics, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
BMJ Case Rep. 2022 Jun 23;15(6):e250455. doi: 10.1136/bcr-2022-250455.
A woman in her 90s with a background of myasthenia gravis and atrial fibrillation presented to hospital following a fall. While in the emergency department it was noted that she was in atrial fibrillation with a fast-ventricular response and as part of her management was given intravenous magnesium. Following this she developed acute respiratory failure and required intubation and ventilation. The patient recovered quickly and was extubated in the intensive care unit the next day. On subsequent days, the patient received two further doses of intravenous magnesium before the link was identified. On both of these occasions she again developed respiratory failure which were managed with non-invasive ventilation. This case highlights the importance of all members of the team being aware of the drugs that can induce a myasthenic crisis. It also stimulates further research into the development of a guide of how to safely treat symptomatic hypomagnesaemia in patients with myasthenia gravis.
一位 90 多岁的女性，有重症肌无力和心房颤动病史，因跌倒后被送往医院。在急诊科，发现她有心房颤动伴快速心室反应，作为治疗的一部分，给予了静脉注射镁。之后，她出现急性呼吸衰竭，需要插管和通气。患者恢复迅速，第二天在重症监护病房拔管。在随后的几天里，在确定关联之前，患者又接受了两次静脉注射镁。在这两次情况下，她再次出现呼吸衰竭，通过无创通气进行了治疗。该病例强调了团队所有成员都要意识到可能引发肌无力危象的药物的重要性。它还促使进一步研究制定如何安全治疗重症肌无力患者症状性低镁血症的指南。
