title: Protocols cure diseases, not patients: flaccid paresis in post-NSTEMI statin treatment.
abstract: An 82-year-old white woman presented at our Internal Medicine ward with flaccid tetraparesis. Two months earlier, she had suffered a non-ST elevation myocardial infarction treated with percutaneous coronary intervention (PCI) and stenting, and she had been prescribed the classical post-PCI therapy (β-blockers, statins and antiplatelet agents). At admission, she was haemodynamically stable and the physical examination revealed reduced reflexes in the four limbs. Urgent laboratory findings revealed mild hypokalaemia. Considering the high statin doses she was taking, we also performed an urgent creatine phosphokinase test, which indicated rhabdomyolysis. Statin therapy was immediately stopped and aggressive fluid treatment begun, supplemented with potassium for increased urinary potassium losses. The patient progressively regained muscle strength.
authors.affiliation: Internal Medicine 2, Pisa's Hospital, Pisa, Tuscany, Italy.
authors.forename: Javier
authors.initials: J
authors.lastname: Rosada
authors.affiliation: Internal Medicine 2, Pisa's Hospital, Pisa, Tuscany, Italy.
authors.forename: Eleni
authors.initials: E
authors.lastname: Rebelos
authors.affiliation: Internal Medicine 2, Pisa's Hospital, Pisa, Tuscany, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Petruccelli
authors.affiliation: Internal Medicine 2, Pisa's Hospital, Pisa, Tuscany, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Taddei
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000369:Aged, 80 and over; D000069059:Atorvastatin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D009203:Myocardial Infarction / Q000628:therapy*; D010291:Paresis / Q000139:chemically induced* / Q000175:diagnosis; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000175:diagnosis; D015607:Stents
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D000069059:Atorvastatin