Jm. Rimaniol et al., MUSCLE WEAKNESS IN INTENSIVE-CARE PATIENTS - INITIAL MANIFESTATION OFVITAMIN-D DEFICIENCY, Intensive care medicine, 20(8), 1994, pp. 591-592
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.