Acute Hypokalemic Myopathy in Alcoholism

To the Editor.—  The article by Rubenstein and Wainapel (Arch Neurol 34:553-555, 1977) described an acute myopathy developed in alcoholics without myalgia or myodema, with marked elevation of serum creatinine phosphokinase (CPK) levels and hypokalemia. The authors also referred to other disorders that produce muscle weakness when associated with hypokalemia induced by diuretics, laxative abuse, chronic gastrointestinal and renal disease, or licorice ingestion.I would like to add to their differential list our own report of steroidinduced hypokalemia, myopathy, and elevated CPK levels in a patient taking fludrocortisone (Florinef) acetate for more than three years for severe orthostatic hypotension.¹ Our patient suffered from a preexistent Shy-Drager syndrome. At the peak of his de novo myopathy symptoms, consisting of extreme, diffuse muscle weakness, his serum potassium level was 1.6 mEq/liter while his serum CPK level was 1,974 units. Results of electrodiagnostic studies were also normal. This patient improved clinically simply