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Alcoholic Myopathy

Myopathic Syndrome Alcoholic

Alcoholic myopathy (AM) affects one-third to more than half of alcohol abusers. It is relieved by withdrawal from alcohol consumption and exacerbated by continued misuse. In acute stages, myopathy presents as rhabdomyolysis. Alcoholic myopathy usually refers to the chronic form and mainly affects the skeletal muscle.


Presentation

Acute high dose intake of alcohol may lead to rhabdomyolysis. Most literature, when describing alcoholic myopathy (AM) suggests the chronic condition, that is precipitated by chronic alcohol abuse and is characterized by varying degrees of muscle weakness and atrophy, prominent in proximal muscle groups. It is a common cause of myopathy [1].

AM is progressive, and its severity is determined by the amount of alcohol consumed, as well as the duration of abuse [2] [3]. Furthermore, those who suffer from liver cirrhosis are more prone to the ailment [4]. In Western countries, it is thought to be the most widely encountered type of myopathy [5] [1]. Although abstinence is advised, some muscle dysfunction is permanent, thus the theory that there are multiple factors at play in the pathogenesis, such as nutrient deficiency, particularly vitamin B [6] [7] [8] is also suggested. The presence of the latter makes the clinical picture more obscure and impedes the treatment.

Acute myopathy may result in death due to renal failure and electrolyte imbalance. Rhabdomyolysis may be seen in more severe cases, while milder cases may witness a rise in creatinine kinase. Necrosis of muscle tissue, as well as weakness and pain, are also recognized.

Chronic AM has a more insidious onset, symptoms include gait disturbances, muscle weakness, and wasting. Recovery is slower than in the acute form. Muscle pain may or may not be present, moreover, neuropathy can occur simultaneously but should be treated as a separate medical entity.

Leg Swelling
  • At that point, the symptoms occur due to heart failure and may include: Ankle, feet, and leg swelling Awakening during the night with shortness of breath (paroxysmal nocturnal dyspnea) Breathing difficulty while lying down (orthopnea) Cough containing[flipper.diff.org]
Pharyngitis
  • Abstract A 38-year-old man experienced six severe episodes of rhabdomyolysis and two episodes of pharyngeal muscle weakness superimposed on chronic alcoholic myopathy and complicated by cardiomyopathy.[ncbi.nlm.nih.gov]
Blurred Vision
  • This results in double and blurred vision, slurring of speech, loss of consciousness and inability to judge distances. 4. Effect on Cardio Vascular System (CVS): (i) Small doses dilate the blood vessels of skin (specially of the face) and stomach.[yourarticlelibrary.com]
Myopathy
  • Alcoholic myopathy (AM) affects one-third to more than half of alcohol abusers. It is relieved by withdrawal from alcohol consumption and exacerbated by continued misuse. In acute stages, myopathy presents as rhabdomyolysis.[symptoma.com]
  • Abstract To determine the significance of type II fiber atrophy in alcoholic myopathy and its relationship with ethanol-related diseases a prospective study was carried out in 100 chronic alcoholics who showed clinical suspicion of skeletal myopathy.[ncbi.nlm.nih.gov]
  • Abstract Chronic myopathy is a common complication of alcoholism, but its natural history has not been well described.[ncbi.nlm.nih.gov]
  • Of the CAM patients, 24 (55%) presented clinical symptoms of myopathy, whereas proximal muscle atrophy was observed in 15 patients (35%).[ncbi.nlm.nih.gov]
  • The ultrastructural features of the alcoholic myopathies provide further support. The resemblance between vitamin E-deficiency myopathy and the alcoholic myopathies is strong additional evidence in favor of this hypothesis.[ncbi.nlm.nih.gov]
Pharyngeal Muscle Weakness
  • Abstract A 38-year-old man experienced six severe episodes of rhabdomyolysis and two episodes of pharyngeal muscle weakness superimposed on chronic alcoholic myopathy and complicated by cardiomyopathy.[ncbi.nlm.nih.gov]

Workup

Diagnosis is made by combining the clinical picture, histological and laboratory findings. Muscle atrophy as a result of impaired synthesis as well as apoptosis may be evaluated microscopically, and type II fibers are most affected [1] [3]. Type I muscle fibers are usually normal [9].

In high magnification studies, acute alcohol intake also produces histological evidence of cell injury where damage to cell organelles such as the mitochondria, sarcoplasmic reticulum is visualized, together with the failure of fat and glycogen storage regulatory mechanisms and cell edema. The histological picture is similar to that of alcoholic liver disease [10]. Further tests, conducted routinely when presented with a patient suffering from a myopathy, include:

  • Laboratory tests: Mostly, these comprise of measuring serum levels of creatinine kinase, myoglobin, creatinine, urea, aspartate aminotransferase (AST) as well as determining the erythrocyte sedimentation rate (ESR). Full blood count and thyroid function tests may also be advised.
  • Urinalysis: This is carried out to demonstrate myoglobinuria, which is a positive finding in alcoholic myopathy.
  • Electrocardiogram (ECG) tracings may be requested and may show signs of hyperkalemia such as wide QRS complexes, lengthened PR intervals and other wave changes.
Wide QRS Complex
  • Electrocardiogram (ECG) tracings may be requested and may show signs of hyperkalemia such as wide QRS complexes, lengthened PR intervals and other wave changes.[symptoma.com]

Treatment

  • Treatment includes quitting drinking. Quitting drinking often results in improved heart function. Continued alcohol consumption, on the other hand, will continue to make alcoholic cardiomyopathy worse.[northshore.org]
  • Discussions around the web We found 8 discussions Treato does not review third-party posts for accuracy of any kind, including for medical diagnosis or treatments, or events in general. Treato does not provide medical advice, diagnosis or treatment.[treato.com]
  • The presence of the latter makes the clinical picture more obscure and impedes the treatment. Acute myopathy may result in death due to renal failure and electrolyte imbalance.[symptoma.com]
  • Medina, seeks to underline the magnitude of neurologic diseases related to malnutrition and the importance of early detection and opportune treatment.[books.google.de]
  • By GRETCHEN REYNOLDS Photo Credit Getty Images You asked How to Stop a Hot Flash Effective treatments are available to stop the discomfort of menopause symptoms.[nytimes.com]

Prognosis

  • Prognosis This depends on the specific diagnosis. The primary disorders are incurable conditions with varied prognosis. Secondary myopathy may be corrected by treating the underlying cause.[patient.info]
  • Prognosis Complete recovery from Wernicke's syndrome may follow prompt administration of thiamine. However, repeated episodes of encephalopathy or prolonged alcohol abuse may cause persistent dementia or Korsakoff psychosis.[medical-dictionary.thefreedictionary.com]
  • In cases suspected to be a primary inflammatory myopathy, specific autoantibodies can be considered to determine the prognosis and rule out associated conditions.[clevelandclinicmeded.com]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • Clues to these other etiologies are often apparent in the history.[clinicaladvisor.com]
  • […] and cirrhosis Ethanol metabolism and its consequences Mechanisms in the pathogenesis of ALD, including genetics, immunology, and insulin-like growth factors Extrahepatic effects of ALD and the role of alcohol in potentiating liver damage due to other etiologies[books.google.it]
  • Rhabdomyolysis may also be seen with infectious etiologies, alcohol, and toxic exposures.[clevelandclinicmeded.com]

Epidemiology

  • This review details the epidemiology of alcoholic myopathy, potential contributing pathophysiologic mechanisms, and emerging literature on novel therapeutic options.[ncbi.nlm.nih.gov]
  • Neurologic Consequences of Malnutrition begins with an overview of the epidemiology and incidence of malnutrition and neurologic disorders.[books.google.de]
  • Mechanisms in the pathogenesis of ALD, including genetics, immunology, and insulin-like growth factors Extrahepatic effects of ALD and the role of alcohol in potentiating liver damage due to other etiologies Interaction of alcohol with viral hepatitis Epidemiology[books.google.it]
  • EPIDEMIOLOGY One third of heavy long-term alcohol consumption (of any beverage type), aka alcoholics, in both sexes and all races, develop skeletal myopathy.[flipper.diff.org]
  • Epidemiology These are all relatively uncommon diseases: Duchenne muscular dystrophy is easily the most common childhood-onset muscular dystrophy and affects 1 in 3,300 boys. [ 6 ] The prevalence of Duchenne muscular dystrophy is 63 cases per million.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • This review details the epidemiology of alcoholic myopathy, potential contributing pathophysiologic mechanisms, and emerging literature on novel therapeutic options.[ncbi.nlm.nih.gov]
  • Methods: We reviewed the literature on alcoholic myopathy and hypovitaminosis D myopathy and compared the pathophysiological findings to designate possible mechanisms of vitamin D action in alcohol-related myopathy.[research.vu.nl]
  • The Gale Encyclopedia of Public Health states, 2002 - Alcoholic cardiomyopathy: incidence, clinical characteristics, and pathophysiology, Piano MR., 2002 SYMPTOMS Alcoholic myopathy can have serious symptoms and side effects.[flipper.diff.org]
  • Muskiet, a professor of pathophysiology and clinical chemical analysis at the University Medical Center Groningen.[sciencedaily.com]
  • Muskiet, a professor of pathophysiology and clinical qualitative analysis on the University Medical Center Groningen.[medimoon.com]

Prevention

  • Increasing dietary potassium raised serum potassium but did not prevent EAM.[ncbi.nlm.nih.gov]
  • However, alpha-tocopherol supplementation has failed to prevent either the loss of skeletal muscle protein or the reductions in protein synthesis in alcohol-dosed animals.[ncbi.nlm.nih.gov]
  • We also unexpectedly found that, in some alcoholics, a substantial reduction in the amount of alcohol consumed may be as effective as complete abstinence in improving muscle strength or preventing its deterioration.[ncbi.nlm.nih.gov]
  • It helps prevent damage caused by high LDL, the "bad" cholesterol.[webmd.com]

References

Article

  1. Preedy VR, Adachi J, Ueno Y, et al. Alcoholic skeletal muscle myopathy: definitions, features, contribution of neuropathy, impact and diagnosis. Eur J Neurol. 2001;8(6):677–687.
  2. Sacanella E, Fernandez-Sola J, Cofan M, et al. Chronic alcoholic myopathy: diagnostic clues and relationship with other ethanol-related diseases. QJM. 1995;88(11):811–817.
  3. Fernández-Solà J, Nicolás JM, Fatjó F, et al. Evidence of apoptosis in chronic alcoholic skeletal myopathy. Hum Pathol. 2003;34(12):1247–1252.
  4. Preedy VR, Ohlendieck K, Adachi J, et al. The importance of alcohol-induced muscle disease. J Muscle Res Cell Motil. 2003;24(1):55–63.
  5. Adachi J, Asano M, Ueno Y, et al. Alcoholic muscle disease and biomembrane perturbations (review). J Nutr Biochem. 2003;14(11):616–625.
  6. Estruch R, Sacanella E, Fernandez-Sola J, Nicolas JM, Rubin E, Urbano-Marquez A. Natural history of alcoholic myopathy: a 5-year study. Alcohol Clin Exp Res. 1998;22(9):2023–2028.
  7. Fernandez-Sola J, Sacanella E, Estruch R, Nicolas JM, Grau JM, Urbano-Marquez A. Significance of type II fiber atrophy in chronic alcoholic myopathy. J Neurol Sci. 1995;130(1):69–76.
  8. Nicolas JM, Garcia G, Fatjo F, et al. Influence of nutritional status on alcoholic myopathy. Am J Clin Nutr. 2003;78(2):326–333.
  9. Preedy VR, Crabb DW, Farres J, Emery PW. Alcoholic myopathy and acetaldehyde. Novartis Found Symp. 2007;285:158–177 (discussion 177–182, 198–159).
  10. Del Villar Negro A, Merino Angulo J, Rivera-Pomar JM. Skeletal muscle changes in chronic alcoholic patients. A conventional, histochemical, ultrastructural and morphometric study. Acta Neurol Scand. 1984;70(3):185–196.

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Last updated: 2018-06-22 06:11