1/4. Steroid-induced myopathy in the ICU.OBJECTIVE: To report a case of steroid-induced myopathy resulting from prolonged administration of corticosteroids in an asthmatic patient in a medical intensive care unit. CASE SUMMARY: A 30-year-old white man presented with status asthmaticus requiring intubation for respiratory failure. His hospital course was complicated by the need for reintubation and the development of "quadriplegia." electromyography does not identify neuropathy. After rapid tapering of systemic steroids, the patient quickly regained muscle strength, was extubated, and was transferred to a rehabilitation facility for prolonged physical therapy. DISCUSSION: Steroid-induced myopathy is a rare occurrence in the intensive care setting. Cases of myopathy that have been reported have been associated with prolonged and combined use of corticosteroids with neuromuscular blocking agents or aminoglycosides. Corticosteroids are thought to produce deleterious effects through 1 or all of 3 main pathways: altered electrical excitability of muscle fibers, loss of thick filaments, and/or inhibition of protein synthesis. All of these pathways are believed to increase the rate of muscle catabolism and result in loss of muscle movement. CONCLUSIONS: Steroid-induced myopathy is a complication of high-dose steroid use. Unfortunately, in this patient, initial treatment of status asthmaticus required intravenous steroids in high doses to adequately treat the presenting illness. Clinicians should be aware of neuromuscular findings and act aggressively to appropriately eliminate systemic steroids from the treatment regimen.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. rehabilitation of patients with quadriparesis after treatment of status asthmaticus with neuromuscular blocking agents and high-dose corticosteroids.Patients with severe status asthmaticus who do not respond to intensive medical therapy are often given neuromuscular blocking agents to facilitate mechanical ventilation. Of 51 consecutive asthmatic patients treated with mechanical ventilation, 27 were treated with neuromuscular blocking agents. Of these 27 patients, all receiving high-dose intravenous steroids, four were noted to develop quadriparesis that was more severe distally. There was no cranial nerve or sensory involvement. These four patients were given physical and occupational therapy; three were transferred to the rehabilitation unit. Steady improvement in muscle strength was noted; independence in mobility and activities of daily living was achieved by the time of discharge. They were followed as outpatients until full recovery. Although the exact etiology of the complication is not known, acute steroid myopathy facilitated by the use of neuromuscular blocking agents is a likely cause. Based on the excellent recovery potential of these patients, early rehabilitation in this uncommon complication is strongly urged.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/4. Analysis of respiratory mucus glycoproteins in asthma: a detailed study from a patient who died in status asthmaticus.Airway mucus from asthmatics is often unusually solid. The death of a patient in status asthmaticus allowed the collection of 28 g of abnormal airway mucus at autopsy. Its chemical and physical properties were studied to reveal differences from more normal airway mucus. The gel plug taken from the airways could be dispersed in 6 M guanidinium chloride, but it took > 1 wk and 700 ml of extractant to disperse 3 g of exudate completely. In contrast, treatment with 10 mM dithiothreitol, which reduces disulfide bonds, dispersed the gel within seconds. mucins accounted for 25% of the non-dialyzable material in the gel, while dna constituted < 1% and proteoglycans could not be detected. The mucins were similar in architecture and general composition to other respiratory mucins and were present at a high concentration (approximately 40 mg/ml). The majority of mucins were of extreme size (mean M(r) 30-40 x 10(6)) and slow to dissolve, but sequential extraction experiments on the gel exudate demonstrated a proportion of mucins (15%), the most readily extracted, which had a higher density, 1.45-1.55 g/ml, a lower M(r) (11.5 x 10(6)) and were markedly more acidic than the bulk of the mucins. Both major and minor mucin populations were extremely heterogeneous in mass distribution. Electron microscopy of the major mucin species demonstrated extensive networks of molecules many microns in length. The major mucin species was distinctly less acidic than mucins previously described from either normal or diseased airways. Amino acid analysis of fractions across the charge distribution suggested the presence of at least two different mucin proteins occurring as distinct glycoforms.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/4. Diaphragmatic flutter emulating recalcitrant asthma.Diaphragmatic flutter is a rare phenomenon characterized by high-frequency, pulsatile contractions of the thorax and abdominal wall associated with breathlessness. We describe the case of a patient previously treated for status asthmaticus who had physical signs of diaphragmatic flutter. Respiratory inductive plethysmography confirmed the diagnosis, simplifying medical management.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |