Acute Myopathy of Intensive Care
Source: Hanson P, et al. Acute corticosteroid myopathy in intensive care patients. Muscle Nerve 1997;20:1371-1380.
Newly acquired weakness in the intensive care setting (ICU) may result from disease of the peripheral nerve, neuromuscular junction, or muscle. Acute myopathy of intensive care (AMIC) usually follows administration of high-dose corticosteroids in conjunction with neuromuscular blocking agents (NMBAs). Although NMBAs alone may produce AMIC, the role of steroids alone in its pathogenesis is less clear (Zochodne DW, et al. Muscle Nerve 1994;17;285-292).
Four ICU patients developed acute myopathy following high-dose intravenous glucocorticoid treatment for acute respiratory failure. All received propofol and benzodiazepines for sedation and intubation; however, none received NMBAs, and only two were given aminoglycoside antibiotics. AMIC was diagnosed based on elevated serum creatinine kinase, EMG findings of positive waves, and fibrillations in most muscles by 4-12 days, with short duration, low amplitude myopathic motor units as recovery began, and loss of thick filaments on muscle biopsy. Muscle paralysis, regardless of cause, appears to be a predisposing factor for AMIC, and glucocorticoids alone can precipitate its development.
COMMENTARY
AMIC, following high-dose corticosteroid administration, has also been reported with asymmetrical onset, mimicking acute hemiparesis (Sun D, et al. Arch Neurology 1997;53:1420-1422). Pathologic confirmation is particularly critical in such instances and demonstrates the profound thick filament loss characteristic of this entity. Corticosteroid use, in the absence of NMBAs, appears to play a critical role in pathogenesis, but further study of other factors including paralysis and sepsis is essential before a sound understanding of AMIC is achieved. mr
Which of the following is correct? Acute myopathy of intensive care may be seen following:
a. corticosteroid use alone.
b. propofol use alone.
c. benzodiazepine use alone.
d. aminoglycoside use alone.
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