Clinical findings:
(1) critically ill patient, usually with the systemic inflammatory response syndrome (SIRS) or sepsis
(2) onset after admission
(3) recovery after discharge (may take some time)
(4) weakness, pasty or wasted muscles, delay in mobilization and/or unexplained delay in weaning
EMG findings: denervation activity consistent with axonal polyneuropathy
Exclusion of other conditions:
(1) spinal cord injury
(2) porphyria
(3) Guillain-Barre syndrome
(4) microabscesses
(5) myasthenia gravis
(6) motor neuron disease
(7) neuromuscular blocking agents
(8) botulism
(9) metastatic cancer
(10) acid maltase deficiency
The differential diagnosis includes critical illness myopathy.
Management:
(1) Treatment of sepsis or SIRS.
(2) Treatment of other underlying conditions. Intensive insulin therapy can reduce the incidence significantly (Van Der Berghe, 2001).
(3) Either avoid the use of steroids and muscle relaxants, or use the lowest possible dose.
