Alcoholism Myopathy

Skeletal muscles also contribute enzymes to blood. Again, the cause may be poor perfusion, hypotliermia, or direct trauma to the muscles (crush injuries). Infection, inflammation (polymyositis), degenerative changes (dystrophies), drugs, and alcohol (alcoholic myopathy) wid cause enzyme leakage from myocytes. Enzyme release from muscles and other tissues also occurs as a result of anesthesia. 

Category X) and lactation. The HMG-CoA reductase inhibitors are used cautiously in patients with a history of alcoholism, acute infection, hypotension, trauma, endocrine disorders, visual disturbances, and myopathy. 

Acquired disease of muscle is more common than is generally appreciated. It may result from the use of drugs—prescription or nonprescription—that have a recognized capacity to compromise the structure or function of skeletal muscle. Drugs particularly well recognized as myotoxic include clofibrate and its derivatives, anabolic steroids, penicillamine, and emetine. Many nonprescription drugs, including alcohol and laxatives, are directly or indirectly myotoxic. Other forms of acquired myopathies include the acute myopathic conditions caused by the bites of many snakes. 

The myopathy associated with chronic alcohol abuse has also been associated with increased free-radical activity (Martin and Peters, 1985) as have various other toxicity syndromes affecting muscle, such as cocaine toxity (Kloss et al., 1983). Little work appears to have been undertaken on the possible role of free radicals in the inflammatory myopathies, although, by analogy with other inflammatory disorders, this is likely to be an area worthy of further study. 

Ward. R. J. and Peters, T.J. (1992). The antioxidant status of patients with either alcohol-induced liver damage of myopathy. Alcohol and Alcoholism 27, 359-365. 

Specific concomitant medications or consumptions (check specific statin package insert for warnings) fibrates (especially gemfibrozil, but other fibrates too), nicotinic acid (rarely), cyclosporine, azole antifungals such as itraconazole and ketoconazole, macrolide antibiotics such as erythromycin and clarithromycin, protease inhibitors used to treat Acquired Immune Deficiency Syndrome, nefazodone (antidepressant), verapamil, amiodarone, large quantities of grapefruit juice (usually more than 1 quart per day), and alcohol abuse (independently predisposes to myopathy)... 

Other neurological syndromes (e.g., cerebral cortical atrophy, myopathy, cerebellar degeneration) are also associated with alcoholism, but their pathogenesis is less certain than that of nutritional deficiency disorders. Abstinence from alcohol plus vitamin replacement and physical therapy comprise the standard treatment approach for these conditions. 

Nicotinic acid has been associated with the development of myopathy with nocturnal leg aching and cramps, symptoms that can be exacerbated by simultaneous use of other lipid lowering drugs associated with similar adverse effects, or alcohol, which also has myopathic effects (SEDA-15, 413 38). 

Acylcamitine then moves across the mitochondrial membrane via an antiport, which also transports carnitine in the opposite direction. In the mitochondria, carnitine is once more exchanged with CoA, which is a reversal of Equation (19.6), yielding acyl-CoA. Free carnitine is then returned to the extramitochondrial space by the antiport. The carnitine shuttle is shown in Figure 19.5. Carnitine is synthesized in the organism from lysine. The symptoms of carnitine deficiency are muscle weakness, cardiac myopathy, and hypertriglyceridemia. These are observed in certain genetic disorders, alcoholism, hemo-... 

Fetal alcohol syndrome acute encephalopathy (agitation, sedation, ataxia, coma) chronic encephalopathy (cognitive impairment, dementia) myopathy peripheral neuropathy (vitamin Bi deficiency )... 

Cirrhosis, alcoholic hepatitis, pancreatitis, gastric or duodenal ulcer, esophageal varices, middle-age onset of diabetes, gastrointestinal cancer, hypertension, peripheral neuropathies, myopathies, cardiomyopathy, cerebral vascular accidents, erectile dysfunction, vitamin deficiencies, pernicious anemia, and brain disorders including Wemicke-Korsakoff syndrome (mortality rate of untreated Wernicke is 50% treatment is with thiamine)... 

Chronic, heavy, daily alcohol consumption is associated with decreased muscle strength, even when adjusted for other factors such as age, nicotine use, and chronic illness. Heavy doses of alcohol also can cause irreversible damage to muscle, reflected by a marked increase in the activity of creatine kinase in plasma. Muscle biopsies from heavy drinkers also reveal decreased glycogen stores and reduced pyruvate kinase activity. Approximately 50% of chronic heavy drinkers have evidence of type 11 fiber atrophy. These changes correlate with reductions in muscle protein synthesis and serum camosinase activities. Most patients with chronic alcoholism show electromyographical changes, and many show evidence of a skeletal myopathy similar to alcoholic cardiomyopathy. 

---