Question

T. C. is a 66 year old man who has type 2 diabetes, hypercholesteremia, HTN and hypertriglyceridemia. His medications include Glyburide, atorvastatin (Lipitor) and the fibric acid agent gemfibrozil (Lopid). He has a PCN allergy that caused anaphylactic shock. During a vacation to Florida, T. C. began to develop cold symptoms that worsened. He tried to treat himself taking OTC Sudafed, guafenesin (Mucinex), and drinking several glasses of grapefruit juice. When the symptoms worsened, he went to an Urgent Care Clinic next to his hotel. He could not remember the names of his medications. At the clinic he was diagnosed with acute bacterial sinusitis and started on clarithromycin 500 mg. BID. A week after he was treated for his sinus infection, T. C., now back home,began to feel weak, developed a fever, and severe myalgias. He also noticed his urine had become red-brown and thought it meant he was dehydrated. He went to see his doctor, thinking he'd picked up a flu virus while on vacation. His doctor ordered a CBC, CPK, comprehensive metabolic panel, and a urinalysis. Although his CBC was normal, his CPK level was significantly elevated, and his red- brown urine had elevated levels of myoglobin. His metabolic panel revealed an elevated BUN and creatinine, and his LFTS (liver function tests) were also significantly elevated. He was diagnosed with rhabdomyositis. 1. What is causing T.C.'s weakness and myalgias? 2. List 3 things that made T. C.more prone to develop rhabdomyositis? 3. Why was T. C. on the gemfibrozil (Lopid)? 4. What could have caused T. C.'s elevated liver enzymes? 5. Why were his BUN and creatinine levels increased?

Answer 1

1. Rhabdomyositis is the breakdown of damaged skeletal muscle. Muscle breakdown causes the release of myoglobin into the bloodstream. Myoglobin is the protein that stores oxygen in your muscles. This breakdown causes loss of myoglobin and decrease in oxygen leading to weakness and myalgias.

3. Gemfibrozil is a potent lipid regulating drug whose major effects are to increase plasma high density lipoproteins (HDL) and to decrease plasma triglycerides (TG). It is used for T.C to treat hypercholesterolemia and hypertriglyceridemia .

4. Reason for elevated liver enzymes muscle injury. Strenuous exercise or myopathy can cause elevations (especially of AST) without causing any other symptoms

5. BUN and creatinine levels increased because of too much myoglobin in blood causes kidney damage.