|
| |
Table 1. Clues to the cause of neuromuscular weakness in the
critically ill
| Suggestive clinical features |
Diagnosis |
| Fluctuating weakness, fatigability, ptosis |
Myasthenia gravis |
| Preceding infection, vaccination, diarrhoea, sensory symptoms |
Guillain Barre |
| Skin rash |
Dermatomyositis,
vasculitis |
| Episodic abdominal pain, psychiatric illness |
Porphyria |
| History of mosquito bites, asymmetric flaccid weakness,
encephalopathy |
West Nile virus infection |
| Family history, retinitis pigmentosa, fits, mental retardation,
deafness |
Mitochondrial myopathy |
| Critical illness, particularly sepsis |
Critical illness
polyneuropathy & myopathy |
Table 2. Drugs induced weakness
| Clinical syndrome |
Possible culprit drugs |
| Myasthenia like syndrome |
Antibiotics: aminoglycosides, quinolones, imipenem, erythromycin,
polymyxins |
| |
Neuromuscular blockers |
| |
Antiarrhythmics: quinidine, procainamide |
| |
Calcium channel blockers: verapamil, diltiazem |
| |
Beta blockers |
| |
Magnesium (including magnesium containing laxatives and antacids) |
| |
Phenytoin |
| |
Corticosteroids |
| |
Lithium |
| |
D-penicillamine |
| |
Interferon alpha |
| |
Chloroquine |
| Myopathy |
Statins, D-penicillamine, zidovudine, lamivudine, stavudine |
| Rhabdomyolysis |
Fibrates |
Further reading
Maramattom BV, Wijdicks EFM. Acute neuromuscular weakness in the intensive
care unit. Crit Care Med, 2006; 34(11): 2835-2841
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