Acute alcohol myopathy

Q: 54 year old male is admitted to ICU with acute myopathy, rhabdomyolysis, and acute renal failure during his acute binge drinking phase. Which body muscles are most prone to be involved in acute myopathy secondary to alcohol?


Answer: Calf muscles

Acute alcoholic myopathy usually occurs during a binge phase with an underlying history of chronic alcoholism. It can be severe enough to cause rhabdomyolysis, and acute kidney injury (AKI). Underlying hypokalemia and hypophosphatemia play the role. An important lesson to remember is that this is a distinct clinical condition and patient may present without any other conditions which are common in chronic alcoholics like delirium tremens (DT). DT can be differentially diagnosed by the fact that it mostly occurs during the abstinence phase, whereas acute alcoholic myopathy is directly proportional to the quantity of alcohol consumed during binge drinking accompanied by starvation. 

Although muscle tenderness is generalized it is more pronounced at the calf muscles. As expected, elevated CPK level with alcohol history is diagnostic but the gold standard is muscle biopsy showing muscle fiber necrosis with subsequent degeneration and regeneration.

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References:

1. Haller RG, Knochel JP. Skeletal muscle disease in alcoholism. Med Clin North Am 1984; 68:91.

2. Lafair JS, Myerson RM. Alcoholic myopathy. With special reference to the significance of creatine phosphokinase. Arch Intern Med 1968; 122:417. 

3. Martin F, Ward K, Slavin G, et al. Alcoholic skeletal myopathy, a clinical and pathological study. Q J Med 1985; 55:233.