Complications
Muscarinic adverse effects can often be decreased by giving pyridostigmine in combination with glycopyrrolate. Alternatively, loperamide may prove useful for persistent diarrhea when the dose of pyridostigmine cannot be reduced.
Myasthenic crisis is characterized by worsening of muscle weakness, resulting in respiratory failure requiring mechanical ventilation.
Serial measurements of forced vital capacity (FVC) are taken. Indications for mechanical ventilation include FVC 15 mL/kg or less (normal ≥60 mL/kg) and/or negative inspiratory force (NIF) 20 cm H₂O or less (normal ≥70 cm H₂O).
Physicians should not wait for abnormal arterial blood gas (ABG) as it occurs late in the course after clinical decompensation. Clinical judgment is important, independent of specific values of FVC and NIF.[81]
Can lead to myasthenic crisis necessitating mechanical ventilation. Rarely, patients may require a percutaneous endoscopic gastrostomy tube to sustain nutrition.
Patients with swallowing impairment are at high risk of aspiration. Subsequent respiratory infections, respiratory distress syndrome, and respiratory failure remain a major cause of morbidity and mortality.
Impaired swallowing may lead to aspiration and secondary pneumonia.
Include coagulopathy, thrombocytopenia, electrolyte disturbance, arrhythmias, and hypotension.
Serious adverse effects related to vascular access include bleeding, pneumothorax, venous thrombosis, line infection, and sepsis.
Daily monitoring of coagulation tests, CBC, and electrolytes is recommended.
Include headache, aseptic meningitis, worsening of migraine headache, back pain, fever, chills, hives, and rarely anaphylactoid reactions.
Prophylactic administration of acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) and diphenhydramine may reduce acute side effects such as fever, chills, headache, and back pain. Prophylactic use of intravenous dexamethasone is sometimes helpful, including in people with migraine.
Occasionally, patients may develop reduction of white blood cells, red blood cells, and/or platelets. Renal failure, stroke, or myocardial infarction appear to be more likely to occur in older patients, or patients with cardiovascular disease, renal disease, or diabetes mellitus. Slower infusions reduce the chances of headache, back pain, renal failure, stroke, or myocardial infarction.
Several thyroid disorders have been associated with MG, including thyroglobulin antibody positivity, Graves disease, hyperthyroidism, and Hashimoto thyroiditis. MG is also associated with increased risk for thyroid autoimmunity.[158]
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