Respiratory failure is usually precipitated by infection, surgery, or the rapid tapering of immunosuppressive drugs. Otherwise minor illnesses, such gastroenteritis or upper respiratory infections, can worsen MG. The neurologist always should be consulted before making a disposition.
Several drugs are known to affect neuromuscular function, and caution must be exercised with their use in MG patients. Drugs that should be avoided are listed in Tab]e226:1. If a drug is absolutely necessary, such as steroids for status asthmaticus, equipment for emergency endotracheal intubation should be immediately available because respiratory failure can develop rapidly.
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