A 76-year-old woman arrives with altered mental status in winter. Triage acuity is ESI 1; T 91.8 F, BP 82/46 mm Hg, HR 44/min, RR 8/min. She has dry

Question

A 76-year-old woman arrives with altered mental status in winter. Triage acuity is ESI 1; T 91.8 F, BP 82/46 mm Hg, HR 44/min, RR 8/min. She has dry skin, periorbital edema, delayed reflexes, and sodium 122 mEq/L. Which of the following is the most appropriate disposition?

Accepted Answer

Admit to the ICU for IV thyroid hormone, stress-dose steroids, and ventilatory support as needed

Answer

Transfer to outpatient endocrine clinic

Answer

Discharge after passive warming

Answer

Send home with oral levothyroxine adjustment

Answer

Observe in urgent care overnight

Myxedema coma — ABEM Board MCQ

A 76-year-old woman arrives with altered mental status in winter. Triage acuity is ESI 1; T 91.8 F, BP 82/46 mm Hg, HR 44/min, RR 8/min. She has dry skin, periorbital edema, delayed reflexes, and sodium 122 mEq/L. Which of the following is the most appropriate disposition?