Myasthenia Gravis

• The most common cause of death during a myasthenic crisis is respiratory failure due to weakness of the diaphragm, intercostal muscles, or both.
• Myasthenia Gravis is an autoimmune disease causing skeletal muscle weakness due to low acetylcholine levels leading to low secretions
• Signs and symptoms of Myasthenia Gravis include:

  • Ptosis (drooping eyes)
  • Decreased eye & eyelid movements
  • Diplopia (double vision)
  • Dysphagia (choking/gagging when eating)
  • Dyspnea
  • Tiredness with slight exertion
  • Myasthenic crisis: muscles won’t allow breathing
  • Strabismus (lazy eye)
  • Muscle weakness worsens with activity and improves with rest
  • Mask-like face appearance, lack of energy, slurred speech
• Most dangerous complications of Myasthenia Gravis include diaphragm weakness and Myasthenic crisis leading to severe muscle weakness and respiratory failure
• Cholinergic crisis, another complication, leads to severe muscle weakness and respiratory failure due to excessive anticholinesterase medication, presenting with pupil constriction, bronchoconstriction, high saliva and mucous, GI cramping, diarrhea
• Diagnosis of Myasthenia Gravis is done through the Tensilon test, where injection with edrophonium is given to increase secretions; if it increases, the patient has Myasthenia Gravis
• Interventions for Myasthenia Gravis include airway protection, setting up intubation bedside, encouraging semi-solid foods, giving pyridostigmine before meals, avoiding stress, sun exposure, infections, crowds during flu season, getting vaccines, monitoring for fever, wearing a medic alert bracelet, monitoring respiratory status, cranial nerves, vision, swallowing, and positioning the head of the bed at 30 degrees while eating
• Patient education for Myasthenia Gravis includes understanding that it's not curable but treatable, having larger meals in the morning, scheduling medications before meals, thickening liquids, having small bites, eating soft foods, and performing most activities in the morning
• Medications for Myasthenia Gravis include Neostigmine, pyridostigmine, and anticholinesterase drugs like Edrophonium for diagnosis, which prevents the breakdown of acetylcholine and improves signs and symptoms of Myasthenia Gravis; in cholinergic crisis, signs and symptoms worsen, requiring the antidote Atropine