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Neuromuscular weakness related to critical illness

David Lacomis, MD
Section Editor
Jeremy M Shefner, MD, PhD
Deputy Editor
John F Dashe, MD, PhD


Neuromuscular weakness is a common occurrence in patients who are critically ill, developing in ≥25 percent of patients who are in the intensive care unit (ICU) and ventilated for at least seven days [1]. Weakness is partly a consequence of improved survival in patients with multiorgan failure and sepsis, but may be associated with treatments administered in the ICU.

Neuromuscular weakness in the ICU is most often due to critical illness myopathy or to critical illness polyneuropathy. This topic will review the peripheral neuromuscular disorders of critical illness.


In a critically ill patient who develops flaccid generalized weakness, the major considerations in the differential diagnosis are critical illness myopathy and critical illness polyneuropathy, or a combination of the two. Prolonged neuromuscular junction blockade is rare. Each of these disorders is discussed in detail below.

Other acute and subacute myopathies can occur in critically ill patients, including rhabdomyolysis and cachectic myopathy. In addition, rare acute neuropathies such as Guillain-Barré syndrome can also develop in the ICU, and subclinical myasthenia gravis may become symptomatic during critical illness or treatment with intravenous magnesium and some antibiotics.

Rhabdomyolysis — Some critically ill patients develop rhabdomyolysis due to their illness or medications [2]. (See "Clinical manifestations and diagnosis of rhabdomyolysis".)

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Literature review current through: Sep 2017. | This topic last updated: Aug 24, 2017.
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