Case Report: Increasing Myasthenic Crisis Patient's Functional Capacity by Means of Optimal Nutrition Support

Background/Aims: Myasthenic crisis is a complication of myasthenia gravis characterized by worsening muscle weakness resulting in respiratory failure which eventually require intubation and mechanical ventilation. Nutritional support with optimal energy and protein intake act as a key component for positive clinical outcome. Methods: A 37-year-old female had been admitted to the Intensive Care Unit due to Myasthenic Crisis. Patient was intubated and breathing supported with mechanical ventilation. Nutritional intake was given by enteral route. Nutritional status by Subjective Global Assessment (SGA) showed moderate malnutrition. Laboratory assessment revealed hypoalbuminemia (2.7 g/dl), low haemoglobin (11.5 g/dl), low lymphocyte count (1070/μL), leukocytosis (34.400/μL), and elevated liver enzymes (GOT/GPT = 309 U/L/609 U/L). Gastrointestinal function was normal. Energy calculation was initiated at 1200 kcal was increased gradually as tolerated untill 1800 kkal. Protein composition is 1.7 g/kg IBW (82.62 g) or 27.54% of total calorie. Carbohydrate and fat composition are 45% (135 g) and 20% (28 g) of total calorie intake, respectively. The nutritional therapy included zinc 20 mg and Snakehead fish capsule extract.450 mg. Patient carried out our feeding regimens completely with 100% food recall per oral by day-13. Results: After 20 days, there were some improvement both clinically and by laboratory parameters marked by weaning off from bilevel positive airway pressure machine, handgrip dynamometry power increment (5.8 kg to 11.4 kg), elevated lymphocyte count, elevated albumin level(2.7 g/dl to 3.7 g/dl), decreased leukocyte count and decreased hepatic liver enzyme. Conclusion: Optimal nutritional support for myasthenic crisis, improve immunity and increases functional capacity.