Myopathy critical illness

As mentioned above severe OP poisoning is often complicated by the critical illness which is very often accompanied by the so-called critical illness myopathy. Such a condition is even more likely after OP poisoning which specifically causes myopathy (Dettbam et al, 2006). It is therefore important to find out whether OP intoxication affects IL-6 signaling and consequently muscle regeneration. The effects of OP on the IL-6 secretion from human myoblasts can be expected since it has already been reported that OPs drastically interfere with cytokine signaling in mouse immune system (Alluwaimi and Hussein, 2007). 

Critical illness myopathy (CIM) Hyperproteolytic state of myosin ubiquitination Local... 

While cared for in the ICU, critically ill patients can develop muscle weakness and, occasionally, paralysis. Some of these patients have evidence of axonal degeneration (Table 2) and denervation atrophy (Fig. 10) (40). This constellation of findings is known as critical illness polyneuropathy. Sepsis and multiple organ failure, although common in these patients, are not essential prerequisites for the development of critical illness polyneuropathy (40). In other patients, rather than axonopathy, there is evidence of isolated myopathy (critical illness myopathy) (Fig. 11) (40). Patients developing isolated myopathy have often been treated with steroids and neuromuscular blocking agents (40). 

Examples of injuries and deficits axonal injury, critical illness myopathy myelin injury, Guillain-Barre neuromuscular conduction defect, myasthenia, prolonged neuromuscular blockade myopathy, critical illness myopathy. 

Although features of myopathy can be recorded by electromyographic studies, electromyography cannot always distinguish critical illness myopathy from critical illness polyneuropathy, and muscle biopsies may be... 

Hund, E. (1999). Myopathy in critically ill patients. Crit. Care Med. 27, 2544-7. 

Hund, E. (2001b). Neurological complications of sepsis critical illness polyneuropathy and myopathy. J. Neurol. 248 929-34. 

Differential diagnoses include structural lesions, such as myelopathy and infections including HTV, lyme disease, CMV, rarely paralytic rabies (Sheikh et al., 2005), and, in endemic areas, polio. In children botulism should be considered. Toxic and metabolic conditions such as tick bite and porphyria can also mimic GBS. In the intensive care setting, critical illness neuropathy and quadriplegic myopathy may be clinically indistinguishable from GBS. 

The increased myopathy may be due to an additive effect as both neuromuscular blockers and corticosteroids can cause myopathy. Results of an in vitro study suggested that the combination of vecuronium and meth-ylprednisolone might augment pharmacologic denervation, which may lead to myopathy and contribute to the prolonged weakness observed in some critically ill patients. ... 

Imbalance between work of breathing and respiratory muscle capacity Critical illness polyneuropathy or myopathy Upper airway obstraction (e.g., tracheal stenosis)... 

New-onset respiratory muscle weakness may result from conditions that are unique to mechanically ventilated patients, such as ventilator-associated respiratory muscle dysfunction, sepsis-associated myopathy, and ICU-acquired paresis (63). New-onset respiratory muscle weakness may also result from conditions that are not unique to critically ill patients, such as acid-base disorders, electrolyte disturbances, decreased oxygen delivery, and medications (63). 

In the last few years, it has become increasingly apparent that critical illness neuropathy and myopathy often coexist, and it has become common to refer to these patients as simply having ICU-acquired paresis (26,83). ICU-acquired paresis is an independent risk factor of prolonged weaning (26). In an investigation, tight control of hyperglycemia reduced the risk of ICU-acquired paresis and the duration of mechanical ventilation (84). 

Latronico N, Fenzi F, Recupero D, et al. Critical illness neuropathy and myopathy. Lancet 1996 ... 

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