LETTER TO THE EDITOR


https://doi.org/10.5005/jp-journals-10071-23499
Indian Journal of Critical Care Medicine
Volume 24 | Issue 7 | Year 2020

Reply to the Letter to Editor Regarding “An Unusual Case of Critical Illness Polyneuromyopathy”


Madhulika Mahashabde1, Gaurav Ashok Chaudhary2, Gangadharam Kanchi3, Shalesh Rohatgi4, Prajwal Rao5, Rahul Patil6, Varun Nallamothu7

1–3,6,7Department of General Medicine, Dr DY Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
4,5Department of Neurology, Dr DY Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India

Corresponding Author: Gangadharam Kanchi, Department of General Medicine, Dr DY Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, Phone: +91 8801999535, e-mail: gangadharamkanchi@hotmail.com

How to cite this article Mahashabde M, Chaudhary GA, Kanchi G, Rohatgi S, Rao P, Patil R, et al. Reply to the Letter to Editor Regarding “An Unusual Case of Critical Illness Polyneuromyopathy”. Indian J Crit Care Med 2020;24(7):604–605.

Source of support: Nil

Conflict of interest: None

ABSTRACT

Critical illness myopathy (CIM), critical illness polyneuropathy (CIP), and critical illness polyneuromyopathy (CIPNM) are the group of disorders that are commonly presented as neuromuscular weakness in intensive care unit (ICU) settings. They are responsible for prolonged ICU stay and failure to wean off from mechanical ventilation.1 We report one such case of young female who was admitted with undiagnosed type I diabetes mellitus with diabetic ketoacidosis with severe hypokalemia with sepsis developed acute-onset quadriplegia and diaphragmatic palsy within 72 hours of ICU admission. Detailed investigation led to the diagnosis of critical illness polyneuromyopathy. In view of high morbidity, mortality, and poor prognosis, a guided approach to diagnoses and treatment in earliest possible duration might give better improvement and outcome of the illness. Despite all the odds, our patient showed good clinical improvement and finally got discharged.

Keywords: Critical illness myopathy, Critical illness polyneuromyopathy, Diabetic ketoacidosis (DKA).

Sir,

At first, we are at immense pleasure to thank you and your team for publishing our case report “An Unusual Case of Critical Illness Polyneuromyopathy” in your Journal IJCCM. We are glad to receive and answer to some of the concerns being raised by your readers.

We want to emphasize critical illness polyneuromyopathy (CIPNM), which is an important entity to suspect in critically ill patients with multisystem involvement and develops acute-onset flaccid paralysis. So, we have decided to publish this case report to discuss our views in approaching a case of ICU-acquired weakness and the differential diagnoses.

Reply to the major concerns raised:

Thus, we diagnosed this patient to have had CIPNM after ruling out all other possible causes of acute-onset flaccid paralysis in ICU. If the patient had developed paralysis due to hypokalemia, patient would have had improved after correcting large potassium deficits. Only after patient got infused with IVIg, she showed drastic neurological improvement in power, tone, and was weaned off mechanical ventilation in the following days. Despite having bad prognosis in most of the cases of CIPNM, our patient survived with almost complete recovery.

REFERENCES

1. Geerse DA, Bindels AJ, Kuiper MA, Roos AN, Spronk PE, Schultz MJ. Treatment of hypophosphatemia in the intensive care unit: a review. Critical Care 2010;14(4):R147. DOI: 10.1186/cc9215.

2. Shepherd S, Batra A, Lerner DP. Review of critical illness myopathy and neuropathy. Neurohospitalist 2017;7(1):41–48. DOI: 10.1177/1941874416663279.

3. Zhou C, Wu L, Ni F, Ji W, Wu J, Zhang H. Critical illness polyneuropathy and myopathy: a systematic review. Neural Regen Res 2014;9(1):101. DOI: 10.4103/1673-5374.125337.