EpistemisGeneralized weakness due to metabolic wear and tear
Specialty: General.
Why it occurs
- Uncontrolled primary hyperthyroidism or active Graves' disease (hypermetabolic state that increases cellular consumption of ATP and accelerates the catabolism of muscle and adipose reserve proteins)
- Long-term active clinical Cushing's syndrome (massive muscle degradation induced by chronic excess of glucocorticoids on myofibrils)
- Chronic decompensated diabetes mellitus with massive glycosuria (massive caloric loss through urine and persistent osmotic dehydration)
- Severe primary hyperparathyroidism with accelerated bone and muscle resorption
- Mitochondrial disorders primary or secondary to mitochondrial toxicity due to drugs or toxins (which prevent normal oxidative phosphorylation).
Initial workup
Determination of fasting glucose and glycosylated hemoglobin (HbA1c), complete thyroid profile (TSH, free T4, free T3), 24-hour urinary free cortisol (or dexamethasone suppression test), serum calcium and phosphorus, intact parathyroid hormone (iPTH), and total creatine phosphokinase (CPK).
red flags
Respiratory muscle weakness that compromises tidal volume, rapid-onset dysphagia for solids and liquids, cardiac rhythm disturbance with multifocal atrial tachycardia or atrial fibrillation with rapid response, or confusion and metabolic delirium.
Standard management
- Thiamazole or Methimazole — 10 to 20 mg orally per day if hyperthyroidism is confirmed as the cause of accelerated metabolic wear, monitoring the liver profile and blood count
- Propranolol — 20 to 40 mg orally every 8 hours to reduce tachycardia and concomitant hyperadrenergic state
- Specialized nutritional supplementation with high caloric density and balanced contribution of proteins of high biological value.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- General
- Listed causes
- 5
- Treatment options
- 3