Muscle function tests

However, in a study in 10 myasthenic patients with mild to moderate symptoms, intravenous propranolol 100 micrograms/kg did not result in a worsening of neuromuscular transmission (assessed by muscle function tests and repetitive nerve stimulation), even though 8 of those with mild symptoms had reduced their pyridostigmine dose during the study to allow the effects of the additional drug to be more readily seen. ... 

During tiie ongoing assessment, tiie nurse assesses the respiratory status every 4 hours and whenever tiie drug is administered. The nurse notes the respiratory rate, lung sounds, and use of accessory muscles in breathing, hi addition, tiie nurse keeps a careful record of the intake and output and reports any imbalance, which may indicate a fluid overload or excessive diuresis. It is important to monitor any patient with a history of cardiovascular problems for chest pain and changes in the electrocardiogram. The primary health care provider may order periodic pulmonary function tests, particularly for patients with emphysema or bronchitis, to help monitor respiratory status. 

Monitor for adequate perfusion of vital organs through assessment of mental status, creatinine clearance, liver function tests, and a stable HR between 50 and 100 beats per minute. Additionally, adequate skin and muscle blood perfusion and normal pH is desirable. 

Nursing Implications Monitor CBC, urinalysis, renal function tests Periodically evaluate renal and hematologic systems during prolonged therapy do not inject into gluteal muscle in children less than 2 years of age... 

Suxamethonium sensitivity," prolonged paralysis of respiratory muscle function caused by failure to cleave the short-acting muscle relaxant succinylcholine widely used in anesthesia, was made testable with a simple bedside assay in 1968 (Motulsky and Morrow). However, that test was not incorporated widely into practice. Most anesthesiologists felt they could simply monitor all patients and "bag" those not resuming respiratory action, without testing for a trait that would be found in only one of 2000 patients. 

Adverse reactions may include abdominal pain, abnormal involuntary movements, abnormal liver function tests, aching joints or muscles, acute urinary retention, adenopathy or lymphadenopathy, aggravation of coronary artery disease, aggravation of disseminated lupus erythematosus, agranulocytosis, albuminuria, alopecia, alterations in pigmentation, anorexia, aplastic anemia, arrhythmias, asthma, AV P.729... 

The most prominent and often limiting feature of dantrolene administration is dose-dependent muscle weakness. Other side effects are drowsiness, dizziness, malaise, fatigue, and diarrhea. Symptomatic hepatitis is reported in 0.5% of patients receiving it and fatal hepatitis in up to 0.2%. Contraindications include respiratory muscle weakness and liver disease. It is suggested that patients on dantrolene therapy be given regular liver function tests. 

Clinical findings may include hypertrophied muscles, acne, oily skin, hirsutism in females, gynecomastia in males, and needle punctures. Edema and jaundice may develop in heavy users. Common laboratory abnormalities include elevated hemoglobin and hematocrit measurements, elevated low-density lipoprotein cholesterol and depressed high-density lipoprotein cholesterol levels. Liver function test results may be elevated, and luteinizing hormone levels are usually depressed. 

Muscle force can be elicited by nerve stimulation to test both muscle function and the integrity of the nerve-muscle connection or by direct muscle stimulation to evaluate only muscle contractile independent of the synapse. The latter measure reflects the total force that the muscle is able to generate, if it is significandy... 

At age 12, the patient was admitted with acute chest pain from a left spontaneous pneumothorax (air within the pleural cavity).This required hospitalization and chest tube insertion, but he recovered without sequelae. After the resolution of this problem, pulmonary function testing revealed findings of both severe airway obstruction and destruction of alveolar lung tissue, consistent with emphysema. No further pulmonary problems occurred until the patient was age 16 years, when he developed occasional episodes of bronchospasm (spasmodic contraction of the smooth muscles of the bronchus). Pulmonary function studies at that time, though improved from those immediately following his pneumothorax, still revealed combined obstructive and destructive lung disease. 

Statins are well absorbed after administration orally, and are metabolised in the liver. They are well tolerated, the commonest adverse effect being transient, and usually minor abnormality of liver function tests in some 1% of patients. Asymptomatic elevation of muscle enzymes (creatine phos-phokinase, CPK) and myositis (with a generalised muscle discomfort) occur more rarely, but is more frequent when statins are combined with other anti-hyperlidaemic drugs such as fibrates and nicotinic acid patients should be counseled about myositis when these drugs are co-administered. Myositis is also more likely with co-administered anti-HIV protease inhibitors, and with drugs that interfere with metabolism of some statins, e.g. ciclosporin. 

In an open study of tizanidine for neuropathic pain, one patient developed abnormal liver function tests accompanied by nausea and vomiting, fatigue, confusion, weakness, and muscle aches (10). Within three weeks after withdrawal of tizanidine, the liver function tests returned to baseline and the sjmptoms resolved. Two other patients had transient asymptomatic rises in Uver function tests, which returned to normal despite continuation of tizanidine. Transiently raised liver function tests during tizanidine treatment have occasionally been reported before (11-13). 

The majority of patients also had an elevated leukocyte count with modestly elevated levels of aldolase, a marker of muscle injury however, creatine phosphokinase, another indicator of muscle injury, was normal in most patients. This inconsistency between the levels of these two muscle-associated enzymes, previously described in some patients with systemic sclerosis and the toxic oil syndrome (TOS) (see below), is helpful in differentiating EMS from other myopathies (muscle diseases) and from eosinophilic fasciitis (EE) (see below). Approximately one-half of patients had abnormal liver function tests, although the changes were mild. The erythrocyte sedimentation rate, rheumatoid factor, and levels of IgE, complement, and cryoglobulin (all markers of immune dysfunction) were normal in most patients tested. 

Disturbances in lipid metabolism also may occur, resulting in transitory increase of blood values for cholesterol and triglycerides. Liver function and serum lipids should initially be monitored, typically at baseline and at weeks 4 and 8. Serious adverse effects of isotretinoin therapy include increased creatine phosphokinase and blood glucose, as well as photosensitivity, pseudotumor cerebri, excess granulation tissue, hepatomegaly with abnormal liver function tests, bone abnormalities, arthralgias, muscle stiffness, and headaches. ... 

Electromyography—Test of muscle function due to either primary muscle disease or secondary to nerve injury. 

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