eMedicine Specialties > Emergency Medicine > Cardiovascular

Myopathies: Treatment & Medication

Author: Courtney A Bethel, MD, MPH, Clinical Assistant Professor, Department of Emergency Medicine, Mercy Catholic Medical Center, Drexel University School of Medicine
Contributor Information and Disclosures

Updated: Nov 21, 2007

Treatment

Emergency Department Care

  • Respiratory insufficiency, associated cardiomyopathy, heart block, and aspiration may result from severe myopathy. Management is supportive.
  • Patients with rhabdomyolysis warrant inpatient and critical care admission to manage potentially life-threatening renal complications and hyperkalemia.
  • In patients with hypokalemic periodic paralysis, IV or oral potassium replacement may be indicated.
    • Swallowing usually is not impaired, and oral supplementation may blunt the acute attack.
    • IV potassium should be given cautiously, if used at all.
    • Attacks will resolve spontaneously within 4-24 hours, and hyperkalemia may result if potassium supplementation has been excessive.
    • Spironolactone and acetazolamide are useful for prophylaxis of attacks.
  • In patients with hyperkalemic periodic paralysis, attacks are often so brief that no therapy is needed.
    • Some patients find that carbohydrate loading at the onset of symptoms may lessen the attack.
    • Glucose and insulin may be useful in lowering serum potassium levels. Kayexalate has not been shown to be effective.

Consultations

  • Neurologist
  • Rheumatologist
  • Infectious disease specialist

Medication

Management is supportive.

More on Myopathies

Overview: Myopathies
Differential Diagnoses & Workup: Myopathies
Treatment & Medication: Myopathies
Follow-up: Myopathies
References
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References

  1. Ahlawat, S; Sachdev, A. Hypokalaemic paralysis. Postgrad Med J. 1999;75 (882):193-197. [Medline].

  2. Bennett JC, Plum F. Myopathies. In: Cecil Textbook of Medicine. 20th ed. WB Saunders Co;1996:1500-03, 2158-73.

  3. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD. In: Harrison's Principles of Internal Medicine. 14th ed. McGraw-Hill;1998:2473-2483.

  4. Griggs RC, Ptacek LJ. The periodic paralyses. Hosp Pract (Off Ed). Nov 15 1992;27(11):123-6, 129-30, 136-7. [Medline].

  5. Plate AM, Boyle BA. Musculoskeletal manifestations of HIV infection. AIDS Read. Feb 2003;13(2):62, 69-70, 72, 76. [Medline].

  6. Riggs JE, Schochet SS, Joynt RJ, Griggs RC, eds. Muscle disease. In: Clinical Neurology. Vol 4. 1997:1-37.

  7. Stedwell RE, Allen KM, Binder LS. Hypokalemic paralyses: a review of the etiologies, pathophysiology, presentation, and therapy. Am J Emerg Med. Mar 1992;10(2):143-8. [Medline].

  8. Stobo JD, Hellman DB. Myopathies. In: The Principles and Practice of Medicine. 23rd ed. McGraw-Hill; 1996:898-904.

  9. Tintinelli JE, Krome RL, Ruiz E. Emergency Medicine: A Comprehensive Study Guide. 4th ed. McGraw-Hill; 1996:1036.

  10. Wortmann RL. Lipid-lowering agents and myopathy. Curr Opin Rheumatol. Nov 2002;14(6):643-7. [Medline].

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Further Reading

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Keywords

disorder of skeletal muscle, myonosus, sarcoidosis, polymyositis, dermatomyositis, idiopathic myopathies, connective tissue disease, systemic lupus erythematosus, SLE, rheumatoid arthritis, RA, polyarteritis nodosa, acute alcoholic myopathy, drug-induced myopathy, thyrotoxic periodic paralysis, Conn syndrome, primary hyperaldosteronism, muscular dystrophy

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Contributor Information and Disclosures

Author

Courtney A Bethel, MD, MPH, Clinical Assistant Professor, Department of Emergency Medicine, Mercy Catholic Medical Center, Drexel University School of Medicine
Courtney A Bethel, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Jerry Balentine, DO, Professor of Emergency Medicine, New York College of Osteopathic Medicine; Senior Vice President, Chief Medical Officer, Medical Director, Attending Physician in Department of Emergency Medicine, Saint Barnabas Hospital
Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Paul Blackburn, DO, FACOEP, FACEP, Program Director, Department of Emergency Medicine, Maricopa Medical Center; Assistant Professor, Department of Surgery, University of Arizona
Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association
Disclosure: Nothing to disclose.

CME Editor

John Halamka, MD, Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School
John Halamka, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Charles V Pollack, Jr, MD, MA, FACEP, Professor, Department of Emergency Medicine, University of Pennsylvania College of Medicine; Chairman, Department of Emergency Medicine, Pennsylvania Hospital
Charles V Pollack, Jr, MD, MA, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: sanofi-aventis Honoraria Consulting; sanofi-aventis Honoraria Speaking and teaching; Schering-Polugh Honoraria Consulting; Schering-Plough Honoraria Speaking and teaching; The Medicines Company Honoraria Consulting; GlaxoSmithKline Grant/research funds Other

 
 
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