Coma mixedematoso en el paciente con SARS-COV-2. Revisión de la literatura
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Publicado:
Oct 5, 2023
Palabras clave:
Coma mixedematoso, Levotiroxina, Emergencia endocrina, Hipotiroidismo, SARS-COV-2
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Resumen
Introducción. el coma mixedematoso es la máxima expresión del hipotiroidismo no controlado, el cual puede presentarse en pacientes que están atravesando una enfermedad sistémica, tal como el SARS-COV-2, generando una mayor mortalidad del paciente debido a la interacción fatal que forman están dos patologías al presentarse en conjunto. Objetivo. Realizar una actualización acerca del diagnóstico y manejo del coma mixedematoso en el paciente con SARS-COV-2. Metodología. se realizó una revisión bibliográfica tipo conceptual, acerca del coma mixedematoso en el paciente con SARS-COV-2, extrayendo la información de diversas bases científicas de datos como: PubMed, Scielo, Science Direct, entre otros; mediante parte de la estrategia PRISMA. Resultados. en pacientes con SARS-COV-2 y coma mixedematoso, se observan signos vitales notables, como bradicardia, hipotensión, eutermia y baja saturación de oxígeno. Esto puede ser resultado de la interacción entre ambas patologías. El coma mixedematoso puede originarse directa o indirectamente debido a la infección, especialmente en pacientes en cuidados intensivos con síndrome de distrés respiratorio. Por lo tanto, es crucial evaluar la función tiroidea en pacientes con SARS-COV-2, especialmente en casos graves. Conclusión. En pacientes con infección por SARS-COV-2, se debe considerar la evaluación del perfil tiroideo debido a la posibilidad de desarrollar coma mixedematoso. Este diagnóstico debe tenerse en cuenta en casos de alteración de la conciencia con temperatura corporal normal o baja, incluso durante una infección. En estos pacientes, la prevalencia de coma mixedematoso es más alta en mujeres (90% en casos analizados), y la relación entre la frecuencia respiratoria y la saturación de oxígeno no es siempre inversamente proporcional. La hipotensión es común (72.73%) y a menudo está asociada con una disminución en la presión de pulso debido a efectos negativos en la función cardíaca y vasoconstricción. Área de estudio general: medicina Área de estudio específica: medicina general
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Martínez Gómez, K. O., & Calvo Campoverde, E. G. (2023). Coma mixedematoso en el paciente con SARS-COV-2. Revisión de la literatura. ConcienciaDigital, 6(4), 112-144. https://doi.org/10.33262/concienciadigital.v6i4.2698
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Abraldes, J. G., Caraceni, P., Ghabril, M., & Garcia-Tsao, G. (2023). Update in the Treatment of the Complications of Cirrhosis. *Clinical Gastroenterology and Hepatology*. https://www.sciencedirect.com/science/article/pii/S1542356523002276
Ahmadi, S., Wang, S., Nagpal, R., Wang, B., Jain, S., Razazan, A., ... & Wang, T. D. (2019). A human-origin probiotic cocktail ameliorates aging-related leaky gut and inflammation via modulating the microbiota/taurine/tight junction axis. JCI Insight, 5(9), e132055.
Bellafante, D., Gioia, S., Faccioli, J., Riggio, O., Ridola, L., & Nardelli, S. (2023). Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution. Journal of Clinical Medicine, 12(3), 1187.
Butterworth, R. F. (2019). Hepatic Encephalopathy in Cirrhosis: Pathology and Pathophysiology. Drugs, 79(Suppl 1), 17-21.
Coronel-Castillo, C. E., Contreras-Carmona, J., Frati-Munari, A. C., Uribe, M., & Méndez-Sánchez, N. (2020). Efficacy of rifaximin in the different clinical scenarios of hepatic encephalopathy. Revista de Gastroenterología de México, 85(1), 56-68.
Di Marco, L., La Mantia, C., & Di Marco, V. (2022). Hepatitis C: Standard of Treatment and What to Do for Global Elimination. Viruses, 14(3), 505.
Enomoto, H., Ueno, Y., Hiasa, Y., Nishikawa, H., Hige, S., Takikawa, Y., ... & Nishiguchi, S. (2020). Transition in the etiology of liver cirrhosis in Japan: a nationwide survey. Journal of Gastroenterology, 55(3), 353-362.
Faccioli, J., Nardelli, S., Gioia, S., Riggio, O., & Ridola, L. (2022). Minimal Hepatic Encephalopathy Affects Daily Life of Cirrhotic Patients: A Viewpoint on Clinical Consequences and Therapeutic Opportunities. *Journal of Clinical Medicine*, 11(23), 7246.
González-Regueiro, J. A., Higuera-de la Tijera, M. F., Moreno-Alcántar, R., & Torre, A. (2019). Fisiopatología y opciones de tratamiento a futuro en la encefalopatía hepática. Revista de Gastroenterología de México, 84(2), 195-203.
Green, E. W., & Mitra, A. (2022). Diagnosis and management of hepatic encephalopathy: A summary for patients. *Clinical Liver Disease*, 20(3), 90-92.
Grgurevic, I., Podrug, K., Mikolasevic, I., Kukla, M., Madir, A., & Tsochatzis, E. A. (2020). Natural History of Nonalcoholic Fatty Liver Disease: Implications for Clinical Practice and an Individualized Approach. *Canadian Journal of Gastroenterology and Hepatology*, 2020, e9181368.
Gu, W., Hortlik, H., Erasmus, H. P., Schaaf, L., Zeleke, Y., Uschner, F. E., ... & Más autores. (2022). Trends and the course of liver cirrhosis and its complications in Germany: Nationwide population-based study (2005 to 2018).
Hepatic Encephalopathy: Definition, Pathogenesis, Clinical Features of Hepatic Encephalopathy. (2023, June 30). [Citado el 7 de julio de 2023]. Disponible en:
Huang, D. Q., Terrault, N. A., Tacke, F., Gluud, L. L., Arrese, M., Bugianesi, E., ... & Más autores. (2023). Global epidemiology of cirrhosis — aetiology, trends, and predictions. Nat Rev Gastroenterol Hepatol, 1-11.
Inmunoprvenibles-SE-38.pdf.
Jalan, R., & Rose, C. F. (2022). Heretical thoughts into hepatic encephalopathy. Journal of Hepatology, 77(2), 539-548.
Kasper, P., Tacke, F., & Michels, G. (2022). [Management of acutely decompensated liver cirrhosis in emergency and critical care medicine]. *Medizinische Klinik - Intensivmedizin und Notfallmedizin*, 117(1), 73-82.
Li, B., Zhang, C., & Zhan, Y. T. (2018). Nonalcoholic Fatty Liver Disease Cirrhosis: A Review of Its Epidemiology, Risk Factors, Clinical Presentation, Diagnosis, Management, and Prognosis. *Canadian Journal of Gastroenterology and Hepatology*, 2018, e2784537.
Luo, M., Ma, P., Li, L., & Cao, W. K. (2019). Advances in psychometric tests for screening minimal hepatic encephalopathy: From paper-and-pencil to computer-aided assessment. Turkish Journal of Gastroenterology: The Official Journal of Turkish Society of Gastroenterology, 30(5), 398-407.
Luo, M., Yu, X. B., Hu, S. J., & Bai, F. H. (2020). EncephalApp Stroop App predicts poor sleep quality in patients with minimal hepatic encephalopathy due to hepatitis B-induced liver cirrhosis. Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association, 26(3), 120-128.
Moctezuma-Velazquez, C., Castro-Narro, G., Simó, P., Viayna, E., Aceituno, S., Soler, M., ... & Belaiche, J. (2022). Economic evaluation of long-term albumin uses in cirrhosis patients from the Mexican healthcare system perspective. *Annals of Hepatology*, 27(2), 100673.
Pawar, V. B., Surude, R. G., Sonthalia, N., Zanwar, V., Jain, S., Contractor, Q., ... & Mishra, S. (2019). Minimal Hepatic Encephalopathy in Indians: Psychometric Hepatic Encephalopathy Score and Inhibitory Control Test for Diagnosis and Rifaximin or Lactulose for Its Reversal. Journal of Clinical and Translational Hepatology, 7(4), 304-312.
Perez, I. C., Bolte, F. J., Bigelow, W., Dickson, Z., & Shah, N. L. (2021). Step by Step: Managing the Complications of Cirrhosis. Hepatic Medicine: Evidence and Research, 13, 45-57.
Principales resultados de la Encuesta Nacional de Salud y Nutrición 2020 (2021, junio 10).
Puentes, J. C. P., Rocha, H., Nicolau, S., & Ferrão, G. (2018). Effectiveness of the MELD/Na Score and the Child–Pugh Score for the Identification of Palliative Care Needs in Patients with Cirrhosis of the Liver. Indian Journal of Palliative Care, 24(4), 526-528.
Rivera-Flores, R., Morán-Villota, S., Cervantes-Barragán, L., López-Macias, C., & Uribe, M. (2020). Manipulation of microbiota with probiotics as an alternative for treatment of hepatic encephalopathy. Nutrition, 73, 110693.
Shahgond, L., Patel, C., Thakur, K., Sarkar, D., Acharya, S., & Patel, P. (2022). Therapeutic potential of probiotics – Lactobacillus plantarum UBLP40 and Bacillus clausii UBBC07 on thioacetamide-induced acute hepatic encephalopathy in rats. Metabolic Brain Disease, 37(1), 185-195.
Tapper, E. B., Henderson, J. B., Parikh, N. D., Ioannou, G. N., & Lok, A. S. (2019). Incidence of and Risk Factors for Hepatic Encephalopathy in a Population-Based Cohort of Americans with Cirrhosis. Hepatology Communications, 3(11), 1510-1519.
Thanapirom, K., Wongwandee, M., Suksawatamnuay, S., Thaimai, P., Siripon, N., Makhasen, W., ... & Poovorawan, Y. (2023). Psychometric Hepatic Encephalopathy Score for the Diagnosis of Minimal Hepatic Encephalopathy in Thai Cirrhotic Patients. Journal of Clinical Medicine, 12(2), 519.
Torres, D. S., Abrantes, J., & Brandão-Mello, C. E. (2020). Cognitive and neurophysiological assessment of patients with minimal hepatic encephalopathy in Brazil. *Scientific Reports*, 10(1), 8610.
Trebicka, J., Fernandez, J., Papp, M., Caraceni, P., Laleman, W., Gambino, C., ... & Angeli, P. (2020). The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology. *Journal of Hepatology*, 73(4), 842-854.
Trebicka, J., Fernandez, J., Papp, M., Caraceni, P., Laleman, W., Gambino, C., ... & Más autores. (2020). The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology. J Hepatol, 73(4), 842-854.
Velarde-Ruiz Velasco, J. A., García-Jiménez, E. S., Aldana-Ledesma, J. M., Tapia-Calderón, D. K., Tornel-Avelar, A. I., Lazcano-Becerra, M., ... & Más autores. (2022). Evaluación y manejo de emergencias en el paciente con cirrosis. Rev Gastroenterol México, 87(2), 198-215.
Voicu, D. F., Anghel, L., Baroiu, L., & Stan, D. (2020). About Minimal Hepatic Encephalopathy. BRAIN Broad Research in Artificial Intelligence and Neuroscience, 11(1Sup1), 70-77.
Wang, M. W., Ma, W. J., Wang, Y., Ma, X. H., Xue, Y. F., Guan, J., ... & Ren, Z. F. (2023). Comparison of the effects of probiotics, rifaximin, and lactulose in the treatment of minimal hepatic encephalopathy and gut microbiota. Frontiers in Microbiology, 14, 1091167.
Woodhouse, C. A., Patel, V. C., Singanayagam, A., & Shawcross, D. L. (2018). Review article: the gut microbiome as a therapeutic target in the pathogenesis and treatment of chronic liver disease. Alimentary Pharmacology & Therapeutics, 47(2), 192-202.
Xia, X., Chen, J., Xia, J., Wang, B., Liu, H., Yang, L., ... & Xie, Y. (2018). Role of probiotics in the treatment of minimal hepatic encephalopathy in patients with HBV-induced liver cirrhosis. Journal of International Medical Research, 46(9), 3596-3604.
Xu, X. Y., Ding, H. G., Li, W. G., Jia, J. D., Wei, L., Duan, Z. P., ... & Shang, J. Y. (2019). Chinese guidelines on management of hepatic encephalopathy in cirrhosis. World Journal of Gastroenterology, 25(36), 5403-5422.
Yeverino-Gutiérrez, M. L., González-González, M. del R., & González-Santiago, O. (2020). Mortality From Alcohol-Related Liver Cirrhosis in Mexico (2000–2017). *Frontiers in Public Health*, 8. https://www.frontiersin.org/articles/10.3389/fpubh.2020.524356
Ahmadi, S., Wang, S., Nagpal, R., Wang, B., Jain, S., Razazan, A., ... & Wang, T. D. (2019). A human-origin probiotic cocktail ameliorates aging-related leaky gut and inflammation via modulating the microbiota/taurine/tight junction axis. JCI Insight, 5(9), e132055.
Bellafante, D., Gioia, S., Faccioli, J., Riggio, O., Ridola, L., & Nardelli, S. (2023). Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution. Journal of Clinical Medicine, 12(3), 1187.
Butterworth, R. F. (2019). Hepatic Encephalopathy in Cirrhosis: Pathology and Pathophysiology. Drugs, 79(Suppl 1), 17-21.
Coronel-Castillo, C. E., Contreras-Carmona, J., Frati-Munari, A. C., Uribe, M., & Méndez-Sánchez, N. (2020). Efficacy of rifaximin in the different clinical scenarios of hepatic encephalopathy. Revista de Gastroenterología de México, 85(1), 56-68.
Di Marco, L., La Mantia, C., & Di Marco, V. (2022). Hepatitis C: Standard of Treatment and What to Do for Global Elimination. Viruses, 14(3), 505.
Enomoto, H., Ueno, Y., Hiasa, Y., Nishikawa, H., Hige, S., Takikawa, Y., ... & Nishiguchi, S. (2020). Transition in the etiology of liver cirrhosis in Japan: a nationwide survey. Journal of Gastroenterology, 55(3), 353-362.
Faccioli, J., Nardelli, S., Gioia, S., Riggio, O., & Ridola, L. (2022). Minimal Hepatic Encephalopathy Affects Daily Life of Cirrhotic Patients: A Viewpoint on Clinical Consequences and Therapeutic Opportunities. *Journal of Clinical Medicine*, 11(23), 7246.
González-Regueiro, J. A., Higuera-de la Tijera, M. F., Moreno-Alcántar, R., & Torre, A. (2019). Fisiopatología y opciones de tratamiento a futuro en la encefalopatía hepática. Revista de Gastroenterología de México, 84(2), 195-203.
Green, E. W., & Mitra, A. (2022). Diagnosis and management of hepatic encephalopathy: A summary for patients. *Clinical Liver Disease*, 20(3), 90-92.
Grgurevic, I., Podrug, K., Mikolasevic, I., Kukla, M., Madir, A., & Tsochatzis, E. A. (2020). Natural History of Nonalcoholic Fatty Liver Disease: Implications for Clinical Practice and an Individualized Approach. *Canadian Journal of Gastroenterology and Hepatology*, 2020, e9181368.
Gu, W., Hortlik, H., Erasmus, H. P., Schaaf, L., Zeleke, Y., Uschner, F. E., ... & Más autores. (2022). Trends and the course of liver cirrhosis and its complications in Germany: Nationwide population-based study (2005 to 2018).
Hepatic Encephalopathy: Definition, Pathogenesis, Clinical Features of Hepatic Encephalopathy. (2023, June 30). [Citado el 7 de julio de 2023]. Disponible en:
Huang, D. Q., Terrault, N. A., Tacke, F., Gluud, L. L., Arrese, M., Bugianesi, E., ... & Más autores. (2023). Global epidemiology of cirrhosis — aetiology, trends, and predictions. Nat Rev Gastroenterol Hepatol, 1-11.
Inmunoprvenibles-SE-38.pdf.
Jalan, R., & Rose, C. F. (2022). Heretical thoughts into hepatic encephalopathy. Journal of Hepatology, 77(2), 539-548.
Kasper, P., Tacke, F., & Michels, G. (2022). [Management of acutely decompensated liver cirrhosis in emergency and critical care medicine]. *Medizinische Klinik - Intensivmedizin und Notfallmedizin*, 117(1), 73-82.
Li, B., Zhang, C., & Zhan, Y. T. (2018). Nonalcoholic Fatty Liver Disease Cirrhosis: A Review of Its Epidemiology, Risk Factors, Clinical Presentation, Diagnosis, Management, and Prognosis. *Canadian Journal of Gastroenterology and Hepatology*, 2018, e2784537.
Luo, M., Ma, P., Li, L., & Cao, W. K. (2019). Advances in psychometric tests for screening minimal hepatic encephalopathy: From paper-and-pencil to computer-aided assessment. Turkish Journal of Gastroenterology: The Official Journal of Turkish Society of Gastroenterology, 30(5), 398-407.
Luo, M., Yu, X. B., Hu, S. J., & Bai, F. H. (2020). EncephalApp Stroop App predicts poor sleep quality in patients with minimal hepatic encephalopathy due to hepatitis B-induced liver cirrhosis. Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association, 26(3), 120-128.
Moctezuma-Velazquez, C., Castro-Narro, G., Simó, P., Viayna, E., Aceituno, S., Soler, M., ... & Belaiche, J. (2022). Economic evaluation of long-term albumin uses in cirrhosis patients from the Mexican healthcare system perspective. *Annals of Hepatology*, 27(2), 100673.
Pawar, V. B., Surude, R. G., Sonthalia, N., Zanwar, V., Jain, S., Contractor, Q., ... & Mishra, S. (2019). Minimal Hepatic Encephalopathy in Indians: Psychometric Hepatic Encephalopathy Score and Inhibitory Control Test for Diagnosis and Rifaximin or Lactulose for Its Reversal. Journal of Clinical and Translational Hepatology, 7(4), 304-312.
Perez, I. C., Bolte, F. J., Bigelow, W., Dickson, Z., & Shah, N. L. (2021). Step by Step: Managing the Complications of Cirrhosis. Hepatic Medicine: Evidence and Research, 13, 45-57.
Principales resultados de la Encuesta Nacional de Salud y Nutrición 2020 (2021, junio 10).
Puentes, J. C. P., Rocha, H., Nicolau, S., & Ferrão, G. (2018). Effectiveness of the MELD/Na Score and the Child–Pugh Score for the Identification of Palliative Care Needs in Patients with Cirrhosis of the Liver. Indian Journal of Palliative Care, 24(4), 526-528.
Rivera-Flores, R., Morán-Villota, S., Cervantes-Barragán, L., López-Macias, C., & Uribe, M. (2020). Manipulation of microbiota with probiotics as an alternative for treatment of hepatic encephalopathy. Nutrition, 73, 110693.
Shahgond, L., Patel, C., Thakur, K., Sarkar, D., Acharya, S., & Patel, P. (2022). Therapeutic potential of probiotics – Lactobacillus plantarum UBLP40 and Bacillus clausii UBBC07 on thioacetamide-induced acute hepatic encephalopathy in rats. Metabolic Brain Disease, 37(1), 185-195.
Tapper, E. B., Henderson, J. B., Parikh, N. D., Ioannou, G. N., & Lok, A. S. (2019). Incidence of and Risk Factors for Hepatic Encephalopathy in a Population-Based Cohort of Americans with Cirrhosis. Hepatology Communications, 3(11), 1510-1519.
Thanapirom, K., Wongwandee, M., Suksawatamnuay, S., Thaimai, P., Siripon, N., Makhasen, W., ... & Poovorawan, Y. (2023). Psychometric Hepatic Encephalopathy Score for the Diagnosis of Minimal Hepatic Encephalopathy in Thai Cirrhotic Patients. Journal of Clinical Medicine, 12(2), 519.
Torres, D. S., Abrantes, J., & Brandão-Mello, C. E. (2020). Cognitive and neurophysiological assessment of patients with minimal hepatic encephalopathy in Brazil. *Scientific Reports*, 10(1), 8610.
Trebicka, J., Fernandez, J., Papp, M., Caraceni, P., Laleman, W., Gambino, C., ... & Angeli, P. (2020). The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology. *Journal of Hepatology*, 73(4), 842-854.
Trebicka, J., Fernandez, J., Papp, M., Caraceni, P., Laleman, W., Gambino, C., ... & Más autores. (2020). The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology. J Hepatol, 73(4), 842-854.
Velarde-Ruiz Velasco, J. A., García-Jiménez, E. S., Aldana-Ledesma, J. M., Tapia-Calderón, D. K., Tornel-Avelar, A. I., Lazcano-Becerra, M., ... & Más autores. (2022). Evaluación y manejo de emergencias en el paciente con cirrosis. Rev Gastroenterol México, 87(2), 198-215.
Voicu, D. F., Anghel, L., Baroiu, L., & Stan, D. (2020). About Minimal Hepatic Encephalopathy. BRAIN Broad Research in Artificial Intelligence and Neuroscience, 11(1Sup1), 70-77.
Wang, M. W., Ma, W. J., Wang, Y., Ma, X. H., Xue, Y. F., Guan, J., ... & Ren, Z. F. (2023). Comparison of the effects of probiotics, rifaximin, and lactulose in the treatment of minimal hepatic encephalopathy and gut microbiota. Frontiers in Microbiology, 14, 1091167.
Woodhouse, C. A., Patel, V. C., Singanayagam, A., & Shawcross, D. L. (2018). Review article: the gut microbiome as a therapeutic target in the pathogenesis and treatment of chronic liver disease. Alimentary Pharmacology & Therapeutics, 47(2), 192-202.
Xia, X., Chen, J., Xia, J., Wang, B., Liu, H., Yang, L., ... & Xie, Y. (2018). Role of probiotics in the treatment of minimal hepatic encephalopathy in patients with HBV-induced liver cirrhosis. Journal of International Medical Research, 46(9), 3596-3604.
Xu, X. Y., Ding, H. G., Li, W. G., Jia, J. D., Wei, L., Duan, Z. P., ... & Shang, J. Y. (2019). Chinese guidelines on management of hepatic encephalopathy in cirrhosis. World Journal of Gastroenterology, 25(36), 5403-5422.
Yeverino-Gutiérrez, M. L., González-González, M. del R., & González-Santiago, O. (2020). Mortality From Alcohol-Related Liver Cirrhosis in Mexico (2000–2017). *Frontiers in Public Health*, 8. https://www.frontiersin.org/articles/10.3389/fpubh.2020.524356