title: Steroid-induced myopathy in the ICU.
abstract: OBJECTIVE
  To report a case of steroid-induced myopathy resulting from prolonged administration of corticosteroids in an asthmatic patient in a medical intensive care unit.
  
  
  METHODS
  A 30-year-old white man presented with status asthmaticus requiring intubation for respiratory failure. His hospital course was complicated by the need for reintubation and the development of "quadriplegia." Electromyography does not identify neuropathy. After rapid tapering of systemic steroids, the patient quickly regained muscle strength, was extubated, and was transferred to a rehabilitation facility for prolonged physical therapy.
  
  
  CONCLUSIONS
  Steroid-induced myopathy is a rare occurrence in the intensive care setting. Cases of myopathy that have been reported have been associated with prolonged and combined use of corticosteroids with neuromuscular blocking agents or aminoglycosides. Corticosteroids are thought to produce deleterious effects through 1 or all of 3 main pathways: altered electrical excitability of muscle fibers, loss of thick filaments, and/or inhibition of protein synthesis. All of these pathways are believed to increase the rate of muscle catabolism and result in loss of muscle movement.
  
  
  CONCLUSIONS
  Steroid-induced myopathy is a complication of high-dose steroid use. Unfortunately, in this patient, initial treatment of status asthmaticus required intravenous steroids in high doses to adequately treat the presenting illness. Clinicians should be aware of neuromuscular findings and act aggressively to appropriately eliminate systemic steroids from the treatment regimen.
authors.affiliation: Department of Pharmacy Services, Yale-New Haven Hospital, New Haven, CT 06510, USA. Polsonb2@ynhh.org
authors.forename: Bryan W
authors.initials: BW
authors.lastname: Polsonetti
authors.forename: Saju D
authors.initials: SD
authors.lastname: Joy
authors.forename: Luis F
authors.initials: LF
authors.lastname: Laos
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009135:Muscular Diseases / Q000139:chemically induced* / Q000503:physiopathology / Q000534:rehabilitation; D013224:Status Asthmaticus / Q000188:drug therapy
chemical_list: D000305:Adrenal Cortex Hormones