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critical illness myopathy

Etiology: - prolonged (> 7 day) stay in ICU - risk factors - glucocorticoids - neuromuscular-blocking agents - hyperglycemia Pathology: - along with critical illness polyneuropathy, contributes to critical illness weakness Clinical manifestations: - inability to extubate - flaccid predominantly proximal muscle weakness - areflexia may be present - not associated with cognitive impairment Laboratory: - serum creatine kinase elevated - plasma glucose may be elevated Special laboratory: - Medical Research Council muscle scale 1st step in evalutating critical illness weakness [1] - electromyoagraphy (EMG) - absent or dimininished sensory responses - low-amplitude motor units Differential diagnosis: - glucocorticoid myopathy - preserved reflexes, normal serum creatine kinase, EMG only mildly abnormal Management: - supportive - wean off glucocorticoids [1] - see critical illness weakness

Related

critical illness polyneuropathy

General

critical illness weakness; critical illness neuromyopathy

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2017
  2. Griffiths RD, Hall JB. Intensive care unit-acquired weakness. Crit Care Med. 2010 Mar;38(3):779-87. PMID: 20048676
  3. Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G Interventions for preventing critical illness polyneuropathy and critical illness myopathy. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006832 PMID: 19160304
  4. Chawla J, Gruener G. Management of critical illness polyneuropathy and myopathy. Neurol Clin. 2010 Nov;28(4):961-77. PMID: 20816273