Neurologic complications of electrolyte disturbances and acid–base balance

Espay, Alberto J.

doi:10.1016/b978-0-7020-4086-3.00023-0

Cited by 54 publications

(43 citation statements)

References 98 publications

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“…While hypomagnesemia can cause CNS dysfunction per se , it may also be relevant for the pathogenesis of PRES (23). While magnesium levels were normal in our patient, serum levels are not a reliable means to determine total magnesium depletion (24). …”

Section: Discussionmentioning

confidence: 65%

Panitumumab-Associated Encephalopathy after Accidental Intra-arterial Application through Dislocated Central Venous Access Device

et al. 2016

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Acute central nervous system (CNS) toxicity and immune-related side effects are increasingly recognized with the use of monoclonal antibodies for cancer therapy. Here, we report a patient who developed of acute-onset encephalopathy and coma, which began shortly after administration of panitumumab for the treatment of metastatic colorectal cancer. Echocardiography revealed that the drug had been infused into the left cardiac ventricle via a dislocated central venous line. Diffusion-weighted magnetic resonance imaging disclosed multiple cortical hyperintensities, which were preferentially located in the frontal lobes. While the neurological condition improved within a few days, the patient died 4 weeks later. It seems likely that the administration of the antibody via the intra-arterial route contributed to the development of this condition. Toxic encephalopathy may be a hitherto unrecognized complication of panitumumab treatment and should be taken into consideration in patients developing CNS symptoms undergoing this therapy.

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Section: Discussionmentioning

confidence: 65%

Panitumumab-Associated Encephalopathy after Accidental Intra-arterial Application through Dislocated Central Venous Access Device

et al. 2016

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“…It is seen that acute myopathy due to viral myositis or electrolyte imbalance can have early loss of reflexes due to reduced excitability of the muscle fibers. [4612131415]…”

Section: Discussionmentioning

confidence: 99%

“…Raised CK is commonly seen in viral myositis, acute bacterial myositis, rhabdomyolysis, drug- and toxin-induced myopathy, while it is less common in pyomyositis, parasitic or fungal myositis, electrolyte- and endocrine-related myopathy, except for severe hypokalemia and hypothyroidism. [78151617]…”

Section: Discussionmentioning

confidence: 99%

A study of acute muscle dysfunction with particular reference to dengue myopathy

Verma

Holla

Kumar

et al. 2017

Ann Indian Acad Neurol

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Background:Acute myopathy is a common cause of acute motor quadriparesis which has various etiologies with different courses of illness and prognosis depending on the cause. Understanding this diversity helps us in proper approach toward diagnosis, predicting the prognosis, and possible complications and in improving the treatments that are being provided. This study was planned to study the clinical, electrophysiological, and etiological profile of patients presenting with acute myopathy. We also studied how dengue-related acute myopathy differs from other causes and also difference between myopathy due to myositis and hypokalemia in cases of dengue.Materials and Methods:This was a prospective, observational study involving all clinically suspected cases of acute myopathy of not more than 4 weeks duration with raised serum creatine kinase (CK) level. They were subjected to detailed clinical evaluation along with hematological, biochemical, microbiological, and electrophysiological studies and followed-up for outcome at 1 and 3 months. Muscle biopsy and histopathological examination were done in selected patients after taking informed consent. Statistical analysis was performed by appropriate methods using SPSS version 16.0 (Chicago, IL, USA).Results:We evaluated thirty patients of acute myopathy with raised CK level. Seventeen patients had fever, 11 had myalgia, and 5 had skin lesions. All presented with symmetric weakness, 17 (56.7%) patients having predominantly proximal weakness, neck or truncal weakness in 6 (20%), hyporeflexia in 12 (40%), with mean Medical Research Council (MRC) sum score of 46.67 ± 6.0. Eight (mean modified Barthel index [MBI] at presentation - 15 ± 3.7) patients had poor functional status according to MBI and 15 according to modified Rankin scale (MRS) (mean MRS score - 2.5 ± 1.2). Etiology was dengue viral infection in 14 patients; hypokalemia due to various causes other than dengue in 8; pyomyositis in 3; dermatomyositis, polymyositis, thyrotoxicosis, systemic lupus erythematosus, and unknown etiology in one each. Only eight patients had abnormal electrophysiology and seven among nine biopsies done were abnormal. At 1 month, 24 (80.0%) and 23 (76.7%) patients had achieved normal MBI and MRS scores with 28 (93.3) and 27 (90%) patients, respectively, at 3 months. Dengue with hypokalemia had less myalgia, more of hyporeflexia, and lower serum CK compared to those without hypokalemia.Conclusion:Dengue infection and hypokalemia due to various causes are the most common causes of acute myopathy and are associated with rapid and complete recovery within 1 month. Shorter duration of illness, higher MRC sum score, better disability status at presentation, lower serum CK correlate with better outcome. Biopsy was decisive in <20% cases; hence, it is not primary investigation in acute myopathy.

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“…It is also worth mentioning metabolic causes of weakness with hyporeflexia or areflexia including electrolyte disturbances (e.g., hyperpotassemia, hypermagnesemia). 1 The clinician should initially consider laboratory tests and neuroimaging of the spine followed by lumbar puncture with CSF analysis and electrodiagnostic studies. Indeed, the initial investigations revealed normal blood tests (i.e., complete blood count, electrolyte concentrations, creatine kinase, creatinine, and liver functions), and no evidence of progression of the metastatic spine disease on MRI (figure 1).…”

Section: Sectionmentioning

confidence: 99%

Clinical Reasoning: Stepwise paralysis in a patient with adenocarcinoma of lung

2016

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A 54-year-old man presented with pain in the left chest for 3 days. His medical history was remarkable for hyperlipidemia managed with diet and statin. He denied tobacco smoking and consumption of alcohol. Physical examination was unrevealing. The patient was diagnosed with an adenocarcinoma of the lung harboring an epidermal growth factor receptor (EGFR) mutation that metastasized to T2-T4 levels. He was treated with radiotherapy and dexamethasone followed by Gefitinib.In Approximately 2 weeks after his surgery, the patient developed rapidly progressive, severe weakness affecting lower and upper limbs with increasing respiratory discomfort over a 3-day period. The patient was intubated and transferred to the intensive care unit due to respiratory distress. He was alert without obvious cranial nerve dysfunction. Neurologic examination was remarkable for a severe, flaccid tetraparesis (MRC of 1/5 at most in all tested muscles in the lower limbs and MRC of 2/5 at most in all tested muscles in the upper limbs) in addition to diffuse areflexia and neutral plantar responses.Questions for consideration:

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Neurologic complications of electrolyte disturbances and acid–base balance

Cited by 54 publications

References 98 publications

Panitumumab-Associated Encephalopathy after Accidental Intra-arterial Application through Dislocated Central Venous Access Device

Panitumumab-Associated Encephalopathy after Accidental Intra-arterial Application through Dislocated Central Venous Access Device

A study of acute muscle dysfunction with particular reference to dengue myopathy

Clinical Reasoning: Stepwise paralysis in a patient with adenocarcinoma of lung

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