• informationallife_threateningfull_crisis

  Full myasthenic crisis — FVC <15 mL/kg OR NIF magnitude <20 cmH2O OR severe bulbar weakness with aspiration OR hypercapnia → mechanical ventilation indicated (MGFA 2020 Update PMID 33144515)

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalsevereimpending_crisis

  Impending myasthenic crisis — FVC 15–20 mL/kg AND/OR NIF magnitude 20–30 cmH2O AND/OR bulbar progression with single-breath count <15; act BEFORE mechanical ventilation required (MGFA 2020 Update Int Consensus PMID 33144515)

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalseverecholinergic_crisis

  Cholinergic crisis from pyridostigmine overdose — SLUDGE (Salivation, Lacrimation, Urination, Defecation, GI cramping, Emesis) + fasciculations + miosis + bradycardia mimicking myasthenic weakness (MGFA 2020)

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalsevereaspiration_risk

  Severe bulbar weakness with cough / swallow failure / drooling — leading cause of MG mortality (MGFA 2020)

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalseveremusk_phenotype

  MuSK-Ab positive MG (~5–8% of generalised MG) — predominantly bulbar / respiratory / facial / neck flexor weakness; less response to AChE-I; rituximab first-line per international consensus

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalsevereachr_phenotype

  Anti-AChR-Ab positive MG (~80% of generalised MG) — thymus pathology common (hyperplasia or thymoma); responsive to AChE-I, IVIG, PLEX, steroids, eculizumab, efgartigimod, rozanolixizumab, zilucoplan

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalsevereseronegative_phenotype

  Seronegative MG (~5–10%) — standard AChR + MuSK Ab tests negative; clustered-AChR cell-based assay positive in subset; clinical features match generalised MG

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalsevererefractory_failed_two_therapies

  Refractory MG — failed ≥2 prior therapies (typically prednisone + a steroid-sparing IS or PLEX/IVIG); persistent generalised disease despite maximal conventional therapy

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalseverepregnancy_phenotype

  MG in pregnancy — disease course unpredictable (1/3 improve, 1/3 stable, 1/3 worsen); risk of transient neonatal MG from passive antibody transfer (~10–20% of infants)

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalsevereprecipitant_medication_trigger

  Crisis precipitant — recent exposure to an MG-aggravating medication: fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin), aminoglycosides (gentamicin, tobramycin, amikacin), macrolides (azithromycin, erythromycin, telithromycin), magnesium IV (especially obstetric), β-blockers (esp. propranolol, timolol), immune-checkpoint inhibitors (nivolumab, pembrolizumab), procainamide, quinidine, D-penicillamine, succinylcholine

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalseverepregnancy_peripartum_magnesium_special_pop

  MG in pregnancy / peripartum — disease course unpredictable (~1/3 worsen, peak first trimester + first postpartum month); IV magnesium sulfate for pre-eclampsia/eclampsia is CONTRAINDICATED (potent NMJ block → precipitates crisis); transient neonatal MG in ~10–20% of infants from transplacental maternal-antibody transfer (onset within 72 h, resolves 2–4 wk)

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalseverecrisis_differential_routing_and_cholinergic_pivot

  Acute neuromuscular respiratory failure differential — the load-bearing pivot is cholinergic-vs-myasthenic crisis (both cause weakness + respiratory failure in a known-MG patient on pyridostigmine); the discriminating cluster is muscarinic excess (SLUDGE + miosis + fasciculations + bradycardia → cholinergic) vs its absence (→ myasthenic). When the post-test probability of a non-MG mimic dominates, route by engine_id with carryover state (accumulated findings, current FVC/NIF, time-since-onset, therapy stack)

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalmoderateiga_deficiency

  Total IgA <7 mg/dL pre-IVIG — anaphylaxis risk with standard IVIG products

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalmoderatethymoma_detected

  Anterior mediastinal mass on CT/MRI chest — 10–15% of generalised MG; majority AChR-Ab positive

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalmoderatelrp4_phenotype

  Anti-LRP4-Ab positive MG (rare, ~1–3%) — typically milder generalised disease; often double-negative for AChR/MuSK on standard assays; cell-based clustered-AChR assay may upgrade

  Trigger could not be auto-evaluated — needs clinician judgement.
• informationalmoderateoffending_medication_exposure

  Fluoroquinolone / aminoglycoside / macrolide / β-blocker / magnesium / ICI started (legacy id retained for backward compat — superseded by precipitant_medication_trigger above which has the complete avoid list)

  Trigger could not be auto-evaluated — needs clinician judgement.

Workflow calculators

This dossier does not reference any calculators.

• ivig

  first line
  pooled_human_IgG
  2 g/kg total over 5 days (typically 0.4 g/kg/d × 5 d) • IV • daily × 5 d (max: 2 g/kg total)
  triggers: myasthenic_crisis, AChR_positive, IgA_replete
  2020 MGFA — IVIG and PLEX equivalent for AChR; check IgA before infusion (anaphylaxis risk in IgA deficient)
  rxcui 1426680
• plasmapheresis

  first line
  apheresis
  5 sessions over 7–10 days (every other day) • IV/large-bore • 5 sessions q2 days (max: 5 sessions per course)
  triggers: MuSK_positive, rapid_response_needed, IgA_deficiency
  PLEX favoured in MuSK + when faster onset needed (response within 24–72 h vs 5–10 d for IVIG) (AAN 2024)