# Myxedema coma diagnostic score

Myxedema coma score

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/myxedema_coma`
HTML: https://magentlab.com/docs/myxedema-coma
Markdown: https://magentlab.com/docs/myxedema-coma.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Sum Popoveniuc 2014 myxedema coma diagnostic points from caller-assigned thermoregulatory, CNS, GI, precipitating-event, cardiovascular, and metabolic bands and return ≥60 potentially diagnostic or 45–59 at risk.

## When to use

When an agent already has the published Popoveniuc 2014 bands assigned and needs the point total and those conclusion cuts. magent does not measure temperature, GCS, or labs and must not invent a myxedema-coma diagnosis or a thyroid-hormone order.

## When not to use

- Not a medical device.
- Not a thyroid hormone order.
- Not a myxedema-coma diagnosis. A score ≥60 is potentially diagnostic in Popoveniuc 2014; 45–59 could classify patients at risk. Scores <45 are below that at-risk range; that paper does not name a third band.
- magent does not measure temperature, GCS, heart rate, blood pressure, or labs. The caller assigns each published band.
- Cardiovascular extras (other EKG changes, effusion, pulmonary edema, cardiomegaly, hypotension) and metabolic flags are additive as in that table. Thermoregulatory, CNS, GI, and bradycardia are mutually exclusive bands.

## Formula

```
Popoveniuc 2014 = thermoregulatory(gt_35→0, 32_to_35→10, lt_32→20) + cns_effects(absent→0, somnolent_lethargic→10, obtunded→15, stupor→20, coma_seizures→30) + gastrointestinal(absent→0, anorexia_pain_constipation→5, decreased_motility→15, paralytic_ileus→20) + 10*precipitating_event + bradycardia(absent→0, 50_to_59→10, 40_to_49→20, lt_40→30) + 10*other_ekg_changes + 10*pericardial_pleural_effusion + 15*pulmonary_edema + 15*cardiomegaly + 20*hypotension + 10*hyponatremia + 10*hypoglycemia + 10*hypoxemia + 10*hypercarbia + 10*decreased_gfr; max 230; ≥60 potentially_diagnostic, 45–59 at_risk
```

## Citation

[A diagnostic scoring system for myxedema coma](https://doi.org/10.4158/EP13460.OR)
Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, Mete M, Desale S, Wartofsky L
Endocr Pract. 2014;20(8):808-817
DOI: [10.4158/EP13460.OR](https://doi.org/10.4158/EP13460.OR)

## Worked example

### All absent or lowest published bands

Given: `bradycardia=absent, cardiomegaly=false, cns_effects=absent, decreased_gfr=false, gastrointestinal=absent, hypercarbia=false, hypoglycemia=false, hyponatremia=false, hypotension=false, hypoxemia=false, other_ekg_changes=false, pericardial_pleural_effusion=false, precipitating_event=false, pulmonary_edema=false, thermoregulatory=gt_35`

1. Thermoregulatory gt_35 → 0; CNS absent → 0; GI absent → 0; precipitant false → 0; bradycardia absent → 0; remaining cardiovascular and metabolic flags false → 0
2. Score = 0 (max 230); myxedema_coma_band = below_at_risk (<45)


### Published maxima of hypothermia, coma or seizures, and precipitant

Given: `bradycardia=absent, cardiomegaly=false, cns_effects=coma_seizures, decreased_gfr=false, gastrointestinal=absent, hypercarbia=false, hypoglycemia=false, hyponatremia=false, hypotension=false, hypoxemia=false, other_ekg_changes=false, pericardial_pleural_effusion=false, precipitating_event=true, pulmonary_edema=false, thermoregulatory=lt_32`

1. lt_32 → 20; coma_seizures → 30; precipitating_event true → 10; remaining factors 0
2. Score = 60 (max 230); myxedema_coma_band = potentially_diagnostic (≥60). Not a diagnosis or thyroid-hormone order.


## Also searched as

- myxedema coma score
- Popoveniuc 2014
- myxedema coma diagnostic score
- myxoedema coma score
- severe hypothyroidism score
- Popoveniuc Wartofsky myxedema
- myxedema crisis score
- MC diagnostic score

## Parameters

- `thermoregulatory` (string, required): Caller-assigned Popoveniuc 2014 thermoregulatory band. gt_35 (>35 °C) scores 0; 32_to_35 (32–35 °C) scores 10; lt_32 (<32 °C) scores 20. magent does not measure temperature.
- `cns_effects` (string, required): Caller-assigned Popoveniuc 2014 central-nervous-system band. absent scores 0; somnolent_lethargic 10; obtunded 15; stupor 20; coma_seizures 30. magent does not compute GCS or examine the patient.
- `gastrointestinal` (string, required): Caller-assigned Popoveniuc 2014 gastrointestinal band. absent scores 0; anorexia_pain_constipation (anorexia, abdominal pain, or constipation) scores 5; decreased_motility 15; paralytic_ileus 20. magent does not examine the patient.
- `precipitating_event` (boolean, required): Precipitating event as assigned by the caller (true or false). Popoveniuc 2014: true → 10. magent does not take a history.
- `bradycardia` (string, required): Caller-assigned Popoveniuc 2014 bradycardia band. absent scores 0; 50_to_59 (heart rate 50–59) scores 10; 40_to_49 scores 20; lt_40 (<40) scores 30. magent does not measure heart rate.
- `other_ekg_changes` (boolean, required): Other electrocardiogram changes as assigned by the caller (true or false): QT prolongation, low voltage, bundle-branch block, nonspecific ST-T changes, or heart block (Popoveniuc 2014). true → 10. magent does not read an ECG.
- `pericardial_pleural_effusion` (boolean, required): Pericardial or pleural effusion as assigned by the caller (true or false). Popoveniuc 2014: true → 10. magent does not interpret imaging.
- `pulmonary_edema` (boolean, required): Pulmonary edema as assigned by the caller (true or false). Popoveniuc 2014: true → 15. magent does not interpret imaging.
- `cardiomegaly` (boolean, required): Cardiomegaly as assigned by the caller (true or false). Popoveniuc 2014: true → 15. magent does not interpret imaging.
- `hypotension` (boolean, required): Hypotension or shock as assigned by the caller (true or false). Popoveniuc 2014: true → 20. magent does not measure blood pressure.
- `hyponatremia` (boolean, required): Hyponatremia as assigned by the caller (true or false). Popoveniuc 2014: true → 10. magent does not measure sodium.
- `hypoglycemia` (boolean, required): Hypoglycemia as assigned by the caller (true or false). Popoveniuc 2014: true → 10. magent does not measure glucose.
- `hypoxemia` (boolean, required): Hypoxemia as assigned by the caller (true or false). Popoveniuc 2014: true → 10. magent does not measure oxygen.
- `hypercarbia` (boolean, required): Hypercarbia as assigned by the caller (true or false). Popoveniuc 2014: true → 10. magent does not measure carbon dioxide.
- `decreased_gfr` (boolean, required): Decrease in glomerular filtration rate as assigned by the caller (true or false). Popoveniuc 2014: true → 10. magent does not compute GFR.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/myxedema_coma`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "bradycardia": "absent",
      "cardiomegaly": "false",
      "cns_effects": "absent",
      "decreased_gfr": "false",
      "gastrointestinal": "absent",
      "hypercarbia": "false",
      "hypoglycemia": "false",
      "hyponatremia": "false",
      "hypotension": "false",
      "hypoxemia": "false",
      "other_ekg_changes": "false",
      "pericardial_pleural_effusion": "false",
      "precipitating_event": "false",
      "pulmonary_edema": "false",
      "thermoregulatory": "gt_35"
    },
    {
      "bradycardia": "absent",
      "cardiomegaly": "false",
      "cns_effects": "absent",
      "decreased_gfr": "false",
      "gastrointestinal": "absent",
      "hypercarbia": "false",
      "hypoglycemia": "false",
      "hyponatremia": "false",
      "hypotension": "false",
      "hypoxemia": "false",
      "other_ekg_changes": "false",
      "pericardial_pleural_effusion": "false",
      "precipitating_event": "false",
      "pulmonary_edema": "false",
      "thermoregulatory": "gt_35"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/myxedema-coma

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/myxedema_coma",
  "items": [
    {
      "components": [
        {
          "value": "gt_35",
          "factor": "thermoregulatory",
          "points": 0,
          "present": false
        },
        {
          "value": "absent",
          "factor": "cns_effects",
          "points": 0,
          "present": false
        },
        {
          "value": "absent",
          "factor": "gastrointestinal",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "precipitating_event",
          "points": 0,
          "present": false
        },
        {
          "value": "absent",
          "factor": "bradycardia",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "other_ekg_changes",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "pericardial_pleural_effusion",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "pulmonary_edema",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "cardiomegaly",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "hypotension",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "hyponatremia",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "hypoglycemia",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "hypoxemia",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "hypercarbia",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "decreased_gfr",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, Mete M, Desale S, Wartofsky L",
        "doi": "10.4158/EP13460.OR",
        "id": "popoveniuc-2014",
        "pmid": "24518183",
        "source": "Endocr Pract. 2014;20(8):808-817",
        "title": "A diagnostic scoring system for myxedema coma"
      },
      "formula": "myxedema_coma",
      "formula_expression": "Popoveniuc 2014 = thermoregulatory(gt_35→0, 32_to_35→10, lt_32→20) + cns_effects(absent→0, somnolent_lethargic→10, obtunded→15, stupor→20, coma_seizures→30) + gastrointestinal(absent→0, anorexia_pain_constipation→5, decreased_motility→15, paralytic_ileus→20) + 10*precipitating_event + bradycardia(absent→0, 50_to_59→10, 40_to_49→20, lt_40→30) + 10*other_ekg_changes + 10*pericardial_pleural_effusion + 15*pulmonary_edema + 15*cardiomegaly + 20*hypotension + 10*hyponatremia + 10*hypoglycemia + 10*hypoxemia + 10*hypercarbia + 10*decreased_gfr; max 230; ≥60 potentially_diagnostic, 45–59 at_risk",
      "max_score": 230,
      "score": 0,
      "myxedema_coma_band": "below_at_risk"
    },
    {
      "components": [
        {
          "value": "gt_35",
          "factor": "thermoregulatory",
          "points": 0,
          "present": false
        },
        {
          "value": "absent",
          "factor": "cns_effects",
          "points": 0,
          "present": false
        },
        {
          "value": "absent",
          "factor": "gastrointestinal",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "precipitating_event",
          "points": 0,
          "present": false
        },
        {
          "value": "absent",
          "factor": "bradycardia",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "other_ekg_changes",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "pericardial_pleural_effusion",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "pulmonary_edema",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "cardiomegaly",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "hypotension",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "hyponatremia",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "hypoglycemia",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "hypoxemia",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "hypercarbia",
          "points": 0,
          "present": false
        },
        {
          "value": false,
          "factor": "decreased_gfr",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, Mete M, Desale S, Wartofsky L",
        "doi": "10.4158/EP13460.OR",
        "id": "popoveniuc-2014",
        "pmid": "24518183",
        "source": "Endocr Pract. 2014;20(8):808-817",
        "title": "A diagnostic scoring system for myxedema coma"
      },
      "formula": "myxedema_coma",
      "formula_expression": "Popoveniuc 2014 = thermoregulatory(gt_35→0, 32_to_35→10, lt_32→20) + cns_effects(absent→0, somnolent_lethargic→10, obtunded→15, stupor→20, coma_seizures→30) + gastrointestinal(absent→0, anorexia_pain_constipation→5, decreased_motility→15, paralytic_ileus→20) + 10*precipitating_event + bradycardia(absent→0, 50_to_59→10, 40_to_49→20, lt_40→30) + 10*other_ekg_changes + 10*pericardial_pleural_effusion + 15*pulmonary_edema + 15*cardiomegaly + 20*hypotension + 10*hyponatremia + 10*hypoglycemia + 10*hypoxemia + 10*hypercarbia + 10*decreased_gfr; max 230; ≥60 potentially_diagnostic, 45–59 at_risk",
      "max_score": 230,
      "score": 0,
      "myxedema_coma_band": "below_at_risk"
    }
  ]
}
```

## Response fields

- `formula` (string): myxedema_coma
- `formula_expression` (string): Exact expression used
- `score` (integer): Popoveniuc 2014 myxedema coma diagnostic points 0-230
- `max_score` (integer): Always 230
- `myxedema_coma_band` (string): potentially_diagnostic when score is ≥60, at_risk when 45-59, below_at_risk when <45 (Popoveniuc 2014 conclusion). Not a myxedema-coma diagnosis or thyroid-hormone order.
- `components` (array): Per-factor Popoveniuc 2014 points
- `citation` (object): Popoveniuc et al. Endocr Pract 2014 citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "value": "gt_35",
      "factor": "thermoregulatory",
      "points": 0,
      "present": false
    },
    {
      "value": "absent",
      "factor": "cns_effects",
      "points": 0,
      "present": false
    },
    {
      "value": "absent",
      "factor": "gastrointestinal",
      "points": 0,
      "present": false
    },
    {
      "value": false,
      "factor": "precipitating_event",
      "points": 0,
      "present": false
    },
    {
      "value": "absent",
      "factor": "bradycardia",
      "points": 0,
      "present": false
    },
    {
      "value": false,
      "factor": "other_ekg_changes",
      "points": 0,
      "present": false
    },
    {
      "value": false,
      "factor": "pericardial_pleural_effusion",
      "points": 0,
      "present": false
    },
    {
      "value": false,
      "factor": "pulmonary_edema",
      "points": 0,
      "present": false
    },
    {
      "value": false,
      "factor": "cardiomegaly",
      "points": 0,
      "present": false
    },
    {
      "value": false,
      "factor": "hypotension",
      "points": 0,
      "present": false
    },
    {
      "value": false,
      "factor": "hyponatremia",
      "points": 0,
      "present": false
    },
    {
      "value": false,
      "factor": "hypoglycemia",
      "points": 0,
      "present": false
    },
    {
      "value": false,
      "factor": "hypoxemia",
      "points": 0,
      "present": false
    },
    {
      "value": false,
      "factor": "hypercarbia",
      "points": 0,
      "present": false
    },
    {
      "value": false,
      "factor": "decreased_gfr",
      "points": 0,
      "present": false
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, Mete M, Desale S, Wartofsky L",
    "doi": "10.4158/EP13460.OR",
    "id": "popoveniuc-2014",
    "pmid": "24518183",
    "source": "Endocr Pract. 2014;20(8):808-817",
    "title": "A diagnostic scoring system for myxedema coma"
  },
  "formula": "myxedema_coma",
  "formula_expression": "Popoveniuc 2014 = thermoregulatory(gt_35→0, 32_to_35→10, lt_32→20) + cns_effects(absent→0, somnolent_lethargic→10, obtunded→15, stupor→20, coma_seizures→30) + gastrointestinal(absent→0, anorexia_pain_constipation→5, decreased_motility→15, paralytic_ileus→20) + 10*precipitating_event + bradycardia(absent→0, 50_to_59→10, 40_to_49→20, lt_40→30) + 10*other_ekg_changes + 10*pericardial_pleural_effusion + 15*pulmonary_edema + 15*cardiomegaly + 20*hypotension + 10*hyponatremia + 10*hypoglycemia + 10*hypoxemia + 10*hypercarbia + 10*decreased_gfr; max 230; ≥60 potentially_diagnostic, 45–59 at_risk",
  "max_score": 230,
  "score": 0,
  "myxedema_coma_band": "below_at_risk"
}
```

## Errors

- HTTP 400 `invalid_myxedema_coma`: Myxedema coma score inputs must match Popoveniuc 2014 thermoregulatory, neurologic, cardiovascular, gastrointestinal, metabolic, and precipitant bands from that paper. Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [Burch–Wartofsky](https://magentlab.com/docs/burch-wartofsky) — Sum Burch 1993 thyroid-storm points from temperature, CNS effects, GI-hepatic dysfunction, heart rate, heart failure, atrial fibrillation, and precipitating event and return unlikely (<25), impending (25–44), or highly suggestive (≥45).
- [Corrected sodium](https://magentlab.com/docs/corrected-sodium) — Compute expected sodium in hyperglycemia using Katz 1.6 or Hillier 2.4. The formula argument is required.
- [Winters' formula](https://magentlab.com/docs/winters) — Compute expected arterial PCO2 in metabolic acidosis from plasma bicarbonate using the Albert–Winters 1967 formula.

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.