PubMed · 5767925
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G F Nelis. 1969-02-01. [Hyperosmolar coma].. https://pubmed.ncbi.nlm.nih.gov/5767925/
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Patients in the intensive care unit often enter a catabolic state with significant protein loss, which may increase postoperative complications. Nutritional support alone usually does not reverse a catabolic state and thereby induce a positive protein balance. Recent studies suggest that recombinant human growth hormone (rhGH) stimulates protein synthesis and improves protein balance in critically ill patients. An increase in the level of growth hormone often fails to occur in critical illness and injury. We describe the case of a man aged 45 years who underwent laparoscopic fundoplasty for hiatus hernia repair. Because of complications, including perforation of the oesophagus, he entered a sustained catabolic state with negative protein balance and a weight loss approaching 20%. Therefore, on the 29th day after operation we started treatment with rhGH, Norditropin 24 IE/day im. The protein balance became positive three days later. This parameter maintained positive, also after the growth hormone therapy was discontinued 12 days later. The further course was uneventful and the patient was transferred to his local hospital 51 days after the fundoplasty. His condition was improving steadily.
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Myxedema coma is a fatal condition when left unrecognized. With the advent of intensive supportive therapy and the use of intravenous thyroxine, however, mortality for this disorder is declining. Further insights into the pathophysiology of hypothyroidism should lead to more rational approaches to therapy and result in improved survival.