A 47-year-old woman with myasthenia gravis self-increased her pyridostigmine dose. She now presents with BP 138/82, HR 108, RR 18, temp 37.2°C, SpO2 98% on room air. She reports severe diarrhea, profuse sweating, and miosis. Examination reveals visible muscle fasciculations and proximal weakness. Serum potassium is 3.1 mEq/L. She denies recent trauma or infection. Which of the following best explains her current deterioration?
- A)Myasthenic crisis due to too little acetylcholine at nicotinic receptors
- B)Cholinergic crisis from excess acetylcholinesterase inhibitionGABARITO
- C)Lambert-Eaton syndrome
- D)Acute intermittent porphyria
- E)Botulinum toxin poisoning
Explicação
Excess pyridostigmine can cause cholinergic crisis with muscarinic symptoms such as diarrhea, sweating, and miosis plus nicotinic weakness and fasciculations. The autonomic findings distinguish it from pure myasthenic crisis. Ver explicação completa e trilha adaptativa →