Critical illness myopathy – 9/20/17

Remember – a lot of this diagnosis can be made with labs and a good physical exam!

Steroid induced myopathy – normal CK and normal DTRs
Critical illness myopathy/neuropathy – elevated CK and decreased DTRs
GBS – normal CK and decreased DTRs
Inflammatory myopathy – elevated CK with normal DTRs

If you have a patient who had inflammatory myopathy and was receiving steroids for treatment and despite a normalization in CK did not have improvement in weakness – wean off the steroids because this likely now became a steroid induced myopathy!

Calciphylaxis – 9/13/17

This is a RARE entity (only about 5% of ESRD patients) but has a HIGH mortality (60-80% in 1 year!)

Etiology: Abnormal deposition of calcium in the lumen of the arterial vasculature leading to compromised blood flow to the tissues and necrosis

Risk factors: Female sex, autoimmune disease, prednisone or coumadin use, elevated phosphorus levels, obesity, diabetes, and low albumin. Higher risk of development if you have a calcium x phosphorus level > 60-70.

Clinical presentation: Painful subcutaneous nodules with overlying red/brown patches and eventual central necrosis and eschars. Usually located in areas of high adipose tissue (thighs, abdomen, etc)

Treatment: Mostly supportive – have your patients eat a low phosphate diet and use non-calcium containing phosphate binders! (Remember, the calcium containing ones will cause more harm because it will still elevated your calcium x phosphate product!). Studies have shown some benefit to using sodium thiosulfate and hyperbaric oxygen but calciphylaxis cannot be cured.