Myopathies Treatment & Management

Updated: Jul 08, 2022
  • Author: Courtney A Bethel, MD, MPH; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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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. Note the following:

  • 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. Note the following:

  • 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


Consultation with one or more of the following services may be useful:

  • Neurology
  • Rheumatology
  • Infectious disease