Correct!
5. All of the above
Early initiation of immunomodulatory therapy and early use of BiPAP even in patients without hypercarbia can avert the need for mechanical ventilation, but the effectiveness of non-invasive ventilation declines once the patient has developed hypercapnea. Initiation of non-invasive ventilation in MG patients with a PaCO2 < 45mm Hg has been associated with reduced ICU and hospital lengths of stay and a decrease in pulmonary complications despite the presence of bulbar weakness. Facial weakness with poor oral seal and fluctuating degree of muscle weakness makes pulmonary function testing in MG patients unreliable.
Cholinesterase inhibitors such as oral pyridostigmine or parenteral neostigmine can be transiently discontinued to minimize respiratory secretions, but should always be restarted. Immunotherapy consists of either immunoglobulin (IVIG) or plasma exchange guided by clinician preference individualized for each patient. Caution should be exercised with high-dose steroids as one-third or one-half of patients will experience clinically significant weakness within days of starting treatment. Steroid-sparing immunosuppressant such as azathioprine or mycophenolate mofetil may be added to facilitate reduction of steroid dose.
What medications should be avoided in myasthenia gravis crisis? (Click on the correct answer to proceed to the next panel)