Glycogen storage disorders Quiz: Ace Your Exams

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A 20-year-old man comes to the emergency department with painful muscle spasms. He reports that after starting a run, he experiences muscle cramps and fatigue, but these symptoms tend to improve after about 10 minutes of continued activity. His past medical history includes a right knee ACL tear. His temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 16/min, and blood pressure is 125/75 mmHg. Abdominal examination is unremarkable. Rapid fingerstick glucose is 80 mg/dL. Serum creatine kinase levels are elevated. Laboratory investigations are shown below:

 Serum 
 Sodium   140 mEq/L 
 Potassium  4 mEq/L 
 Creatinine   1.3 mg/dL 
 Creatine kinase  645 U/L 
 Urine  
 BUN/Cr  <15 
 Blood   Positive  
 Erythrocytes  0/hpf 
 Leukocytes  2/hpf 
 Fractional excretion of sodium (FENa  >2%  

Electrocardiogram and echocardiogram are unremarkable. Which of the following is the most likely diagnosis?

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