MUSCLE WEAKNESS IN INTENSIVE-CARE PATIENTS - INITIAL MANIFESTATION OFVITAMIN-D DEFICIENCY

A 72-year-old woman was referred to hospital for obnubilation with gen eral muscle weakness and hypotonia. Biology showed hypocalcemia, hypop hosphatemia, increased serum creatine kinase and alkaline phosphatase levels. Brain CT scan, cerebrospinal fluid examination, and electromyo gram were normal. Clinical status and electroencephalogram were consis tent with non-conclusive generalized status epilepticus. The treatment included clonazepam and CaCl2 and consciousness returned to normal. A treatment with multivitamin infusion containing vitamin D-2 was given for 3 weeks. Muscle weakness improved partially. Serum vitamin D-3 le vel was low and osteomalacic myopathy was diagnosed. A treatment was g iven with 250H vitamin D-3, 50 mu g per day. Two months later, serum v itamin D-3 and creatine kinase levels were normal and the patient coul d walk without help. We conclude that vitamin D status should be monit ored in elderly patients with muscle symptoms and abnormal calcium sta tus. Osteomalacic myopathy should be considered in critically ill pati ents with muscle symptoms of an unclear cause.