Pearls for the MRCP:
2 crisis may be seen in myesthenia gravis: Cholinergic crisis, myasthenic crisis
Cholinergic crisis: Hypotension, bronchospasm, abdominal cramping, diarrhea, and flaccid paralysis of the extremities
Edrophonium test can differentiate myasthenic crisis from a cholinergic crisis
There will have no effect (or worsen the situation) in cholinergic crisis after Edrophonium test
History of increased medication(pyridostigmine) usage, worsening symptom and negative edrophonium test
Cholinergic crisis is precipitated by overuse of an acetylcholinesterase inhibitor.
Atropine would be indicated to antagonize cholinergic activity.
Myasthenic crisis:
Management of myasthenic crisis intravenous immunoglobulins / plasmapheresis (quicker)
Intubation and assisted ventilation in myasthenic crisis: Elective intubation should be considered if the vital capacity is less than 20 mL/kg
Md. Reazuddin Danish
MRCP (UK)