Alcoholic myopathy

Question 1

What is acute alcoholic myopathy?

Answer 1

abrupt muscle injury caused by severe alcoholic binges/first few days of withdrawal in alcoholics, leading to swollen painful muscles and rhabdomylosis

Question 2

What are 2 other terms for acute alcoholic myopathy?

Answer 2

1. Alcoholic rhabdomyolysis
2. Acute alcoholic necrotising myopathy

Question 3

Which group of patients are affected by alcoholic myopathy?

Answer 3

malnourished chronic alcoholics

Question 4

What are 2 things which may precipitate alcoholic myopathy?

Answer 4

1. Following a bine
2. In first days of alcohol withdrawal

Question 5

Which 2 factors are necessary to produce the syndrome of alcoholic myopathy?

Answer 5

1. Alcohol - direct toxic effects
2. Nutritional factors - reduced absorption of B vitamins

Question 6

What is the spectrum of severity of alcoholic myopathy?

Answer 6

transient elevation of creatine kinase, to frank rhabdomyolysis with myoglobinuria

Question 7

What is the prognosis for acute alcoholic myopathy?

Answer 7

in most instances, full recovery occurs within days to weeks

Question 8

What severe outcome can sometimes occur from acute alcoholic myopathy and why?

Answer 8

death can occur in the case of acute renal failure and hyperkalaemia

Question 9

What is chronic alcoholic myopathy?

Answer 9

gradually evolving syndrome of proximal weakness, atrophy, and gait disturbances that frequently complicates years of alcohol abuse

Question 10

What are the mechanisms of chronic alcoholic myopathy?

Answer 10

impaired gene expression and protein synthesis, as well as increased oxidative damage and apoptosis

Question 11

What features characterise acute alcoholic myopathy?

Answer 11

develops suddenly in context of binge drinking, painful muscle weakness, myonecrosis

Question 12

Why can acute alcoholic myopathy lead to acute renal failure?

Answer 12

precipitation of myoglobin in the renal tubules can cause acute renal tubular necrosis

Question 13

What is the management of acute alcoholic myopathy?

Answer 13

• aggressive hydration
• administration of mannitol and furosemide to increase diuresis

→to maintain renal function

Question 14

What are 2 key types of investigations that should be performed in suspected acute alcoholic myopathy?

Answer 14

1. Blood tests: CK, U+Es, serum myoglobin, FBC, ESR, LFTs
2. Urinalysis: myoglobinuria

Question 15

What are 6 types of blood tests which should be performed in suspected acute alcoholic myopathy?

Answer 15

1. Creatine kinase (CK)
2. U+Es
3. Serum myoglobin
4. FBC
5. ESR
6. LFTs

Question 16

What will be seen in urinalysis suggestive of myoglobinuria?

Answer 16

myoglobin + few red blood cells on microscopic evaluation