Potential Triggers

Key Point:

Taking a careful history and performing a detailed examination may identify potential triggers for the MC.

Take a careful history and perform a detailed physical examination

Findings, for example fever, upper respiratory tract infection, pneumonia, urinary tract infection, may identify possible triggers for the MC.

Carefully review medication and recent surgery or trauma

Drugs that may worsen MG:

  1. Neuromuscular blockers
  2. Antibiotics: Aminoglycosides, clindamycin, fluroquinolones, ketolides, Vancomycin
  3. Cardiovascular drugs: betablockers, procainamide, quinidine

Others: botulinum toxin, Magnesium, monoclonal antibodies, quinine, chloroquinine, penicillamine

Antibiotics are indicated only if there is strong evidence of infection. Empiric antibiotic use is not recommended as some antibiotics can interfere with neuromuscular transmission. Clostridium difficile infection has been associated with prolonged MC [11].

Baseline investigations include:

  • CXR
  • ECG
  • FBC
  • U&Es
  • C-reactive protein/erythrocyte sedimentation rate
  • Blood culture