What is included in emergency department care (ED) of myopathies?

Updated: Dec 28, 2017
  • Author: Courtney A Bethel, MD, MPH; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Respiratory insufficiency, associated cardiomyopathy, heart block, and aspiration may result from severe myopathy. Management is supportive.

Patients with rhabdomyolysis warrant inpatient and critical care admission to manage potentially life-threatening renal complications and hyperkalemia.

In patients with hypokalemic periodic paralysis, IV or oral potassium replacement may be indicated. Note the following:

  • Swallowing usually is not impaired, and oral supplementation may blunt the acute attack
  • IV potassium should be given cautiously, if used at all
  • Attacks will resolve spontaneously within 4-24 hours, and hyperkalemia may result if potassium supplementation has been excessive
  • Spironolactone and acetazolamide are useful for prophylaxis of attacks

In patients with hyperkalemic periodic paralysis, attacks are often so brief that no therapy is needed. Note the following:

  • Some patients find that carbohydrate loading at the onset of symptoms may lessen the attack
  • Glucose and insulin may be useful in lowering serum potassium levels. Kayexalate has not been shown to be effective

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