A review of the clinical presentation, diagnosis, and management of thyrotoxic crisis is presented along with a discussion on the choice of beta blockade therapy. [ncbi.nlm.nih.gov]

A septic screen should also be performed in all patients presenting acutely unwell, with tachycardia and pyrexia. [endobible.com]

Why it Matters Thyrotoxicosis is a rare presentation to the ED that can masquerade as many other conditions. [emsimcases.com]

• Fever

  However, doses should be altered for each individual patient to ensure that the relative adrenal insufficiency is adequately treated while minimizing the risk of side effects.Supportive Measures In high fever, temperature control is achieved with fever [en.wikipedia.org]

  In addition to the fever of the patient also complained of trembling hands and heart pounding. These two symptom appeared simultaneously with the fever. [biomedpharmajournal.org]

  […] heart beat weakness heart failure confusion /disorientation death Fever tends to be one of the hallmark signs of thyroid storm and can be as high as 105-106 F (40.5-41.1 C). [medicinenet.com]

  Called also developmental crisis. myasthenic crisis the sudden development of dyspnea requiring respiratory support in myasthenia gravis ; the crisis is usually transient, lasting several days, and accompanied by fever. oculogyric crisis a symptom of [medical-dictionary.thefreedictionary.com]

  Case Summary A 31 year-old-female presents by EMS with altered LOC and fever due to thyroid storm precipitated by recent parturition. The patient is tachycardic and hypoxic on arrival. [emsimcases.com]

• Congestive Heart Failure

  A 50-year-old man with Graves' disease developed rhabdomyolysis, congestive heart failure and hepatic failure during the course of thyroid crisis and then died of acute renal failure. [ncbi.nlm.nih.gov]

  Congestive heart failure should be treated with digitalis and diuretics even though congestive failure due to hyperthyroidism may be refractory to digitalis. Cardiac arrhythmias are treated with the usual antiarrhythmic agents. [emjournal.net]

  When left untreated, thyroid storm can cause congestive heart failure or fluid-filled lungs. The mortality rate for people with untreated thyroid storm is estimated to be 75 percent. [healthline.com]

  Systolic and Diastolic Heart Failure. Beta-blockers need to be used with extreme caution in patients with moderate to severe congestive heart failure. [clinicaladvisor.com]

• Goiter

  2016 2017 2018 2019 Non-Billable/Non-Specific Code Applicable To Toxic nodular goiter NOS Thyrotoxicosis with toxic multinodular goiter Approximate Synonyms Thyroid goiter, toxic, nodular, with crisis Toxic multinodular goiter with thyrotoxic crisis [icd10data.com]

  ( Figure 224-0.1 ) Most common of all hyperthyroidism (85% of all cases) Associated with diffuse goiter, ophthalmopathy, and local dermopathy Toxic multinodular goiter Second most common cause of hyperthyroidism Toxic nodular (adenoma) goiter ( Figure [mhmedical.com]

  "Total Thyroidectomy in the Management of Diffuse Toxic Goiter", J. Clin. Endocrinol., 9:1048 (Oct.) 1949. 5. Perinetti, H., M. D., et al.: "Medical-surgical Experience with Goiter in an Endemic District, Mendoza, Argentine". Tr. Am. [revistaendocrino.org]

  […] take months or year to be detected -increased antibodies to thyroid peroxidase enzyme, causes inflammations in thyroid with eventual destruction of gland -before 1920's iodine deficiency was common (mostly Canada) -intro to iodized salt eliminated "goiter [quizlet.com]

  Other causes include multinodular goiter and toxic adenoma. [physio-pedia.com]

• Weakness

  Medical Definition of thyroid storm : a sudden life-threatening exacerbation of the symptoms (as high fever, tachycardia, weakness, or extreme restlessness) of hyperthyroidism that is brought on by various causes (as infection, surgery, or stress) [merriam-webster.com]

  These conditions can include thyroid storm, heart problems, weak and brittle bones, and may even be fatal. Thyroid storm can occur in any person with untreated hyperthyroidism. [medicalnewstoday.com]

  Signs and Symptoms include: Agitation Emotional changes Insomnia Poor heat tolerance Weight loss Headache Tremors Exophthalmos Goiter (Enlarged thyroid gland) Weakness Dyspnea Tachycardia New onset A-fib in the absence of a cardiac history Nervous system [medictests.com]

  […] hyperthyroidism can cause symptoms such as sweating, feeling hot, palpitations and weight loss - symptoms of thyroid storm are more severe, resulting in complications such as: fever dehydration rapid heart rate nausea / vomiting diarrhea irregular heart beat weakness [medicinenet.com]

  Signs and symptoms associated with thyrotoxicosis include 1 : nervousness, anxiety, hyperactivity weight loss muscle weakness, tremor increased perspiration, heat intolerance palpitations, tachycardia or atrial arrhythmia, systolic hypertension stare [radiopaedia.org]

• Weight Loss

  Signs and Symptoms include: Agitation Emotional changes Insomnia Poor heat tolerance Weight loss Headache Tremors Exophthalmos Goiter (Enlarged thyroid gland) Weakness Dyspnea Tachycardia New onset A-fib in the absence of a cardiac history Nervous system [medictests.com]

  Whereas hyperthyroidism can cause symptoms such as sweating, feeling hot, palpitations and weight loss - symptoms of thyroid storm are more severe, resulting in complications such as: fever dehydration rapid heart rate nausea / vomiting diarrhea irregular [medicinenet.com]

  Signs and symptoms associated with thyrotoxicosis include 1 : nervousness, anxiety, hyperactivity weight loss muscle weakness, tremor increased perspiration, heat intolerance palpitations, tachycardia or atrial arrhythmia, systolic hypertension stare [radiopaedia.org]

  People with hyperthyroidism have problems from over-activity of several organs, resulting in symptoms such as sweating, feeling hot, rapid heartbeats, weight loss, and sometimes eye problems. [emedicinehealth.com]

  Rationale: Significant fluid losses through vomiting, diarrhea, diuresis, and diaphoresis can lead to profound dehydration, concentrated urine, and weight loss. Weigh daily. Encourage chair rest or bedrest. Limit unnecessary activities. [rnpedia.com]

• Pneumonia

  It may be precipitated by an illness such as a cerebrovascular accident, myocardial infarction, or an infection such as a urinary tract infection or pneumonia. [accessmedicine.mhmedical.com]

  Although he was initially thought to have sepsis secondary to pneumonia with associated cardiogenic shock, his thyroid function tests indicated severe thyrotoxicosis: TSH 3 29.9 (normal 2.5–5.7 pmol/l), free T 4 46 (normal 9–24 pmol/l). [endocrine-abstracts.org]

  Illnesses such as pneumonia and upper respiratory tract infection can bring one on. Not taking thyroid medication correctly. People with hyperthyroid conditions must take medications to regulate hormone production. [webmd.com]

  However acute exacerbation of thyrotoxicosis typically caused by concurrent illness, especially infections (pneumonia, upper respiratory tract infection, enteric infections), and trauma such as operation, still occur. [shifrinmd.com]

  […] mental status -do not have to be comatose to dx -almost exclusively in pt >60 -occurs in winter months-inability to sense temp change -usually longstanding hypothyroidism -same as hypothyroidism -precipitating factors include infections, particularly pneumonia [quizlet.com]

• Dyspnea

  Signs and Symptoms include: Agitation Emotional changes Insomnia Poor heat tolerance Weight loss Headache Tremors Exophthalmos Goiter (Enlarged thyroid gland) Weakness Dyspnea Tachycardia New onset A-fib in the absence of a cardiac history Nervous system [medictests.com]

  Jaundice Despite Improvements in Heart Failure Hiroshi Yamaguchi, Ayaka Takahashi, Atsuhisa Shirakami, Norihito Kageyama, Ken-ichi Kitazoe, Hiroyuki Fujinaga Abstract We herein present a case of a 33-year-old woman who was referred to our hospital for dyspnea [jofem.org]

  IV Peripheral symptom control (ex. tachycardia, chest pain, dyspnea, etc.) is done primarily through β blockade. Traditionally this has been done with either oral or intravenous propranolol. [saem.org]

  Note development of tachypnea, dyspnea, pallor, and cyanosis. Rationale: O 2 demand and consumption are increased in hypermetabolic state, potentiating risk of hypoxia with activity. [rnpedia.com]

  […] presentation: fever, tachycardia and altered mental status See below for common additional symptoms and signs Organ System Symptoms Signs CNS Anxiety Confusion Delirium Psychosis Lethargy Seizures Coma Hyperreflexia Cardiovascular Palpitations Chest Pain Dyspnea [coreem.net]

• Tachypnea

  Tachypnea. Altered mental status (Spectrum from anxiety and agitation to coma). Eyes i. Stare and lid lag common ii. Suggestive of Graves disease: Proptosis Periorbital edema Chemosis Diplopia Neck. [saem.org]

  Chest pain, fever, tachypnea, and/or tachycardia with subcutaneous emphysema are common features which were found in our case too [ 2 ]. Esophageal perforation is a surgical emergency associated with high morbidity and mortality. [omicsonline.org]

  Note development of tachypnea, dyspnea, pallor, and cyanosis. Rationale: O 2 demand and consumption are increased in hypermetabolic state, potentiating risk of hypoxia with activity. [rnpedia.com]

• Heart Failure

  We herein report a rare case of thyroid crisis with worsening jaundice despite improvements in heart failure. [jofem.org]

  A 50-year-old man with Graves' disease developed rhabdomyolysis, congestive heart failure and hepatic failure during the course of thyroid crisis and then died of acute renal failure. [ncbi.nlm.nih.gov]

  The condition could cause the rapid development of heart failure and pulmonary edema that leads to death, according to MedlinePlus, a site for the National Institutes for Health. [newsmax.com]

  Systolic and Diastolic Heart Failure. Beta-blockers need to be used with extreme caution in patients with moderate to severe congestive heart failure. [clinicaladvisor.com]

• Tachycardia

  A septic screen should also be performed in all patients presenting acutely unwell, with tachycardia and pyrexia. [endobible.com]

  High fever (106 degrees F or higher) Irritability Delirium or Coma Tachycardia Hypotension Vomiting Diarrhea Treatment for these patients is largely focused on supportive care. [medictests.com]

  Tachycardia (130 beats/min or faster) ( Note 3 ) 4. Congestive heart failure (CHF) ( Note 4 ) 5.  [ncbi.nlm.nih.gov]

  Circulation: Tachycardia is common, either sinus tachycardia (most common rhythm) or atrial fibrillation (most common dysrhythmia). Supraventricular and ventricular dysrhythmias, including ventricular fibrillation, may occur. [saem.org]

• Palpitations

  However, reported weight loss, intermittent palpitations, and hand tremors for the past year. [physio-pedia.com]

  Whereas hyperthyroidism can cause symptoms such as sweating, feeling hot, palpitations and weight loss - symptoms of thyroid storm are more severe, resulting in complications such as: fever dehydration rapid heart rate nausea / vomiting diarrhea irregular [medicinenet.com]

  The three main symptoms include: An elevated body temperature – this could be up to 105F or 41C Palpitations Changes in mental status such as anxiety or confusion But other symptoms include: Chest pain Breathing difficulties Fatigue Sweating Heat intolerance [markvanderpump.co.uk]

  Signs and symptoms associated with thyrotoxicosis include 1 : nervousness, anxiety, hyperactivity weight loss muscle weakness, tremor increased perspiration, heat intolerance palpitations, tachycardia or atrial arrhythmia, systolic hypertension stare [radiopaedia.org]

  Patients experiencing thyrotoxicosis (thyroid storm), or symptomatic hyperthyroidism, can experience a number of effects that can include tachycardia, palpitations, tremor and/or nervousness. [ebmconsult.com]

• Chest Pain

  The three main symptoms include: An elevated body temperature – this could be up to 105F or 41C Palpitations Changes in mental status such as anxiety or confusion But other symptoms include: Chest pain Breathing difficulties Fatigue Sweating Heat intolerance [markvanderpump.co.uk]

  Characteristics/Clinical Presentation Classic presentation characterized by signs and Carroll including: [5] Severe tachycardia Elevated blood pressure Heart failure Peripheral edema Pulmonary edema Chest pain Hyperthermia (up to 105.3℉ or 40.7℃) Restlessness [physio-pedia.com]

  Pain Dyspnea on exertion Sinus Tachycardia Atrial fibrillation Widened pulse pressure Heart failure Gastrointestinal Abdominal pain Nausea Vomiting Diarrhea Jaundice Thyroid Gland Neck fullness Tenderness over thyroid Diffuse enlargement Bruit Diagnosis [coreem.net]

  IV Peripheral symptom control (ex. tachycardia, chest pain, dyspnea, etc.) is done primarily through β blockade. Traditionally this has been done with either oral or intravenous propranolol. [saem.org]

• Wide Pulse Pressure

  The actual diagnosis of thyroid storm is made on the basis of suspicion in patients with symptoms described above and physical findings of an enlarged thyroid gland (thyromegaly), wide pulse pressure, and exophthalmos (protruding eyes). [medicinenet.com]

  Hypertension with a wide pulse pressure occurs in early to mid crisis, with hypotension accompanying shock occurring in the late stage. Heart failure and heart attack may occur. Death may occur despite treatment. [en.wikipedia.org]

  Excessive sweating Cardiovascular signs Hypertension with wide pulse pressure Hypotension in later stages with shock Tachycardia disproportionate to fever Signs of high-output heart failure Cardiac arrhythmia (Supraventricular arrhythmias are more common [emedicine.medscape.com]

  pulse pressure Laboratory Tests to Obtain Serum T4, T3, TSH, free-T4 CBC Sodium, potassium, chloride, calcium Plasma cortisol ECG Chest x-ray Laboratory Findings (Similar to other hyperthyroid patients) Elevated serum free-T4, T4, and T3 with suppressed [calsprogram.org]

• Sweating

  Other signs: excessive sweating, shortness of breath, abnormal tenderness with palpation of the thyroid gland, abnormal heart sounds, fever, tremor, and any of the clinical signs listed above. [physio-pedia.com]

  In the absence of previously diagnosed thyrotoxicosis, the history may include symptoms such as irritability, agitation, emotional lability, a voracious appetite with poor weight gain, excessive sweating and heat intolerance, and poor school performance [emedicine.medscape.com]

  […] by, last update April 23, 2019 OVERVIEW life threatening exacerbation of hyperthyroid state with 1 or more organ dysfunction CLINICAL FEATURES may occur 6-24 hours post surgery fever sweating HR >140/min coma nausea and vomiting diarrhoea MANAGEMENT Supportive [lifeinthefastlane.com]

  More Info Here Along with racing heart rate, symptoms may include persistent sweating, shaking, agitation, confusion, high fever, shaking, or unconsciousness, Healthline reports. [newsmax.com]

  Whereas hyperthyroidism can cause symptoms such as sweating, feeling hot, palpitations and weight loss - symptoms of thyroid storm are more severe, resulting in complications such as: fever dehydration rapid heart rate nausea / vomiting diarrhea irregular [medicinenet.com]

• Agitation

  Symptoms are severe and may include any of the following: Agitation Change in alertness (consciousness) Confusion Diarrhea Increased temperature Pounding heart ( tachycardia ) Restlessness Shaking Sweating The health care provider may suspect thyrotoxic [medlineplus.gov]

  It is characterized by a high fever (temperatures often above 40 °C/104 °F), fast and often irregular heart beat, elevated blood pressure, vomiting, diarrhea, and agitation. [en.wikipedia.org]

  A ntibiotics (To combat infection) B enzodiazepines (For agitation) C ooling (External cooling, no salicylates) C arbimazole D igoxin (For cardiac failure) P ropranolol P ropylthiouracil Q uickly act (filler :P) R ehydration S teroids (IV hydrocortisone [medicowesome.com]

  Confusion, agitation, delirium, psychosis, seizures or coma. [patient.info]

  Agitation: Benzodiazepines are the preferred method of management. Vascular instability: Should be aggressively treated with IV fluids. [emdocs.net]

• Confusion

  There was immediate improvement after dantrolene with reduction in muscle rigidity, mental confusion and pyrexia. [ncbi.nlm.nih.gov]

  Nervousness and confusion. People affected by a thyroid storm may have terrible anxiety and become delirious. Unconsciousness. If untreated, the affected person may fall into a coma. If this happens to you or someone you know, call 911 immediately. [webmd.com]

  More Info Here Along with racing heart rate, symptoms may include persistent sweating, shaking, agitation, confusion, high fever, shaking, or unconsciousness, Healthline reports. [newsmax.com]

  To diagnose thyroid storm, the doctor will look to identify any common symptoms of hyperthyroidism, such as high temperature, fast heart rate, nausea and vomiting, or confusion. [medicalnewstoday.com]

  CT head Often necessary to exclude other acute causes of confusion or altered GCS. Cardiac enzymes Myocardial infarction is a recognised trigger for thyroid storm. [endobible.com]

• Tremor

  However, reported weight loss, intermittent palpitations, and hand tremors for the past year. [physio-pedia.com]

  Patients experiencing thyrotoxicosis (thyroid storm), or symptomatic hyperthyroidism, can experience a number of effects that can include tachycardia, palpitations, tremor and/or nervousness. [ebmconsult.com]

  Signs and Symptoms include: Agitation Emotional changes Insomnia Poor heat tolerance Weight loss Headache Tremors Exophthalmos Goiter (Enlarged thyroid gland) Weakness Dyspnea Tachycardia New onset A-fib in the absence of a cardiac history Nervous system [medictests.com]

  […] include: An elevated body temperature – this could be up to 105F or 41C Palpitations Changes in mental status such as anxiety or confusion But other symptoms include: Chest pain Breathing difficulties Fatigue Sweating Heat intolerance Abdominal pain Tremors [markvanderpump.co.uk]

  Non-selective effects of blockade improve tremor, hyperpyrexia, agitation. Relative contraindications include previous heart failure not due to thyrotoxicosis and reactive airway disease. [emdocs.net]

• Altered Mental Status

  mental status Diagnosis can be rapidly made using the Burch-Wartofsky scale. [coreem.net]

  Aggressive management resolve fever, tachycardia and alter mental status in 24 hs. Dispose :ICU Avoid interruption : reoccurrence and death 26. Acute Adrenal Insufficiency 27. Physiology BP 28. [slideshare.net]

  Snapshot A 34-year-old female with a past medical history of well-controlled Graves disease is brought to the emergency room for altered mental status. She is post-operative day 4 from an laparoscopic appendectomy for acute appendicitis. [medbullets.com]

  mental status. [ 3 ] Hyperthyroid crisis classically occurs in patients with underlying Graves' disease or toxic multinodular goitre. [patient.info]

  Fever, diaphoresis, weakness Nausea, vomiting, abdominal pain Tachycardia, hypertension Extreme anxiety, confusion, altered mental status, seizures, coma High-out congestive heart failure, arrhythmias Hypotension may develop late Characterized by MULTIsystem [pedemmorsels.com]

• Agitated Delirium

  Confusion, agitation, delirium, psychosis, seizures or coma. [patient.info]

  Precise criteria for thyroid storm have been defined and include fever, tachycardia, arrhythmias, congestive heart failure, hypotension, hyperpyrexia, agitation, delirium, psychosis, stupor and coma, as well as nausea, vomiting, diarrhea, and hepatic [shifrinmd.com]

  Delirium or psychosis Jaundice Abdominal pain Nausea and vomiting Diarrhea Profuse sweating Dehydration Tremor Coma Central Features: Thyrotoxicosis Abnormal CNS function Fever Tachycardia (above 130bpm) GI tract symptoms Evidence of impending or present [physio-pedia.com]

  Similarly, irritability and restlessness in thyrotoxicosis progress to severe agitation, delirium, seizures, and coma. [1] GI manifestations of thyroid storm include diarrhea, vomiting, jaundice, and abdominal pain, in contrast to only mild elevations [emedicine.medscape.com]

  CNS manifestations range from mild agitation to delirium, psychosis, lethargy, seizures, and coma. [clinicaladvisor.com]

Cholestatic liver injury is mainly depicted by a raised direct hyperbilirubinemia and alkaline phosphatase levels as shown in the patient’s workup. [thyroidresearchjournal.biomedcentral.com]

While some guidelines recommend combining TSH measurements with free thyroxine (FT4) determination ( 2, 3 ), others constrain diagnostic workup on TSH measurements as a first-line diagnostic test and only recommend determining peripheral thyroid hormones [doi.org]

• Increased Basal Metabolic Rate

  Breathing: Tachypnea may occur for numerous reasons: increased basal metabolic rate; underlying heart failure as a complication of longstanding thyrotoxicosis (high output heart failure, dilated cardiomyopathy, or cor pulmonale); or other diseases that [saem.org]

Thyroid Storm Medical Treatment Treatment of thyroid storm consists of life support measures to support vital organ function along with attempts to reduce thyroid hormone release. [emedicinehealth.com]

Thus early thyroidectomy should be considered as the treatment of choice, if medical treatment fails to result in clinical improvement. [shifrinmd.com]

Design, patients and measurements Retrospective analyses were performed on clinical parameters, outcomes, and treatments in 356 TS patients. [doi.org]

Early suspicion, prompt diagnosis and intensive treatment will improve survival in thyroid storm patients. Because of its rarity and high mortality, prospective intervention studies for the treatment of thyroid storm are difficult to carry out. [jstage.jst.go.jp]

The patient’s laboratory data and treatment are summarized in Table 1. Table 1. [academic.oup.com]

We present newly formulated diagnostic criteria for TS and clarify its clinical features, prognosis, and incidence based on nationwide surveys in Japan. [ncbi.nlm.nih.gov]

What is the Prognosis of Thyroid Storm? An untreated Thyroid Storm is usually fatal. [dovemed.com]

(where there is excessive release of stored thyroid hormone without a concomitant increase in synthesis) high-dose radiation therapy surgical manipulation iodinated contrast administration (see: contrast medium-induced thyrotoxicosis ) Treatment and prognosis [radiopaedia.org]

Prompted by the Child-Pugh score, which assesses the prognosis of liver diseases ( 17–19 ), we analyzed whether elevated serum total bilirubin levels were associated with the prognosis of TS1 and TS2. [doi.org]

Etiology There are multiple causes of thyrotoxicosis 1 : hyperthyroidism excessive exogenous thyroid hormone iatrogenesis or ingestion (e.g. hamburger thyrotoxicosis, thyrotoxicosis factitia ) thyroiditis (where there is excessive release of stored thyroid [radiopaedia.org]

Etiology/Causes Thyrotoxicity occurs when there are abnormally high levels of thyroid hormone circulating within the body, most often due to overactivity of the thyroid gland. [physio-pedia.com]

[…] excess thyroid hormone Epidemiology ( Nayak 2006 ) Rare condition that is more common in women (80/100,000 per year) than in men (8/100,000 per year) Extremely rare in children (0.9/100,000 per year) Most cases are due to Graves’ disease Hyperthyroidism Etiologies [coreem.net]

However, these patients are often critically ill and the complications or inciting etiology of the patient’s thyroid storm may require active airway intervention. [saem.org]

(Etiology) Thyroid Storm is caused by dangerously elevated levels of thyroid hormones (T3 and T4) in blood. [dovemed.com]

Introduction Clinical definition life threatening condition characterized by symptoms of severe thyrotoxicosis (excessive thyroid hormone in the body) often precipitated by an acute event/trigger Epidemiology risk factors longstanding, untreated hyperthyroidism [medbullets.com]

Discussion The present study helps clarify the epidemiology of TS, in some regard, for the first time. [doi.org]

Epidemiology Hyperthyroid crisis is rare. [patient.info]

Links: aetiology pathophysiology investigation treatment of thyroid crisis follow-up for hyperthyroidism [gpnotebook.co.uk]

As the nurse taking care of the patient in thyroid storm it is important you understand the signs and symptoms, pathophysiology, causes, nursing interventions, and medical treatments. Don’t forget to take the quiz on thyroid storm. [registerednursern.com]

Every chapter reviews the relevant anatomy and pathophysiology and the latest developments in defining the genetic causes are also considered where appropriate. [books.google.de]

Pathophysiology 30. Pathophysiology 31. Clinical manifestation 32. Causes of 2 nd adrenal insufficiency A. HPA suppression with long term steroids B. Pituitary - infarction - hemorrhage - tumor - infiltrative disease e.g sarcoidosis C. [slideshare.net]

Pathophysiologic mechanisms of Graves disease relating thyroid-stimulating immunoglobulins to hyperthyroidism and ophthalmopathy. T4 is levothyroxine. T3 is triiodothyronine. [emedicine.medscape.com]

The best way to prevent thyroid storm, however, is to address and treat the cause of hyperthyroidism correctly. [medicalnewstoday.com]

If iodide is part of treatment, mix with milk juice, or water to prevent GI distress and administer through a straw to prevent tooth discoloration. [rnpedia.com]

Even with early diagnosis and targeted treatment, the mortality rate of hyperthyroid crisis ranges from 10-30%. [ 4 ] It has a fatality rate of 50-90% if left untreated. [ 7 ] Prevention Identification and prevention or early treatment of precipitating [patient.info]