Phosphorus nuclear magnetic resonance evidence of abnormal skeletal muscle metabolism in chronic alcoholics

Pathophysiologic events leading to rhabdomyolysis in alcoholics are not clearly understood. We examined 18 alcoholic patients (10 with and 8 without a recent history of rhabdomyolysis) and 15 healthy non-alcoholic volunteers by phosphorus nuclear magnetic resonance spectroscopy of thenar eminence muscle. At rest, phosphocreatine, ATP, and pH levels were similar in patients and control subjects. During aerobic exercise, phosphocreatine utilization was greater, pH fell more slowly, and maximum acidosis was less in alcoholics with previous rhabdomyolysis than in control subjects. During ischemic exercise, both patient groups exhibited a significantly slower and smaller decrease in pH than did control subjects. These findings are consistent with impaired muscular glycolysis or glycogenolysis in both alcoholic groups. This metabolic myopathy may contribute to the onset of acute rhabdomyolsis.