A 68-Year-Old Man with Chronic Obstructive Pulmonary Disease (COPD) Experiences

A 68-year-old man with chronic obstructive pulmonary disease (COPD) experiences progressive dyspnea, wheezing, and cough over several days despite using inhaled glucocorticoids and bronchodilators.  His shortness of breath rapidly worsens and emergency medical services (EMS) is called.  The patient becomes unresponsive prior to EMS arrival and is found to have pulseless electrical activity.  Cardiopulmonary resuscitation is begun, and he is endotracheally intubated.  The patient regains spontaneous circulation on arrival to the emergency department and is found to have a large pneumothorax and exacerbation of COPD.  His other medical conditions include hypertension, type 2 diabetes mellitus, and Parkinson disease.  A chest tube is inserted, and the patient is admitted to the intensive care unit for further management.  Over the next several days, his respiratory status gradually improves, but he remains unresponsive despite not receiving any sedation.  The patient is also observed to have recurrent episodes of brief contractions of various muscle groups.  Deep tendon reflexes are normal.  Serum electrolytes are within normal limits.  Which of the following is the most likely cause of the observed findings in this patient?

A) Critical illness polyneuropathy
B) Drug-induced muscle injury
C) Extrapyramidal drug effect
D) Muscle denervation
E) Prolonged cerebral hypoxia

Correct Answer:

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