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December 1965

Malnutrition, Myoedema, and Muehrcke's Lines

Author Affiliations


From the departments of Medicine, King County Hospital and the University of Washington. Dr. Conn is a Teaching and Research Scholar of the American College of Physicians.

Arch Intern Med. 1965;116(6):875-878. doi:10.1001/archinte.1965.03870060073015

IN 1956 Muehrcke 1 described transverse white bands in the fingernails as a reliable sign of significant hypoalbuminemia. To date these bands have remained the sole sign by which the serum albumin level may be predicted and will therefore be referred to as "Muehrcke's lines" throughout this paper.

A second sign which may be of considerable value in predicting the level of serum albumin is myoedema, which is an unusual excitability to mechanical stimulus seen in the trunk and limb muscles. As early as 1837 clinicians observed that myoedema was present in patients with chronic pulmonary disease, and through the years the phenomenon has been noted in patients with a variety of debilitating diseases.2-4 It is the purpose of this report to point out that myoedema is also a reliable sign of significant hypoalbuminemia.

The Signs 

Myoedema.  —Myoedema is elicited by striking a superficial muscle, usually the deltoid or