A Successfully Treated Case of Hyperosmolar Hyperglycemic State Complicated with Rhabdomyolysis, Acute Kidney Injury, and Ischemic Colitis

Abstract

A 48-year-old Japanese male was admitted to our hospital due to hyperosmolar hyperglycemic state (HHS), combined with rhabdomyolysis and acute kidney injury. His blood sugar levels were gradually decreased by fluid resuscitation and insulin infusion; however, his renal function worsened, and he developed bloody stools. He required continuous hemodiafiltration to improve his hemodynamics. As colonoscopy revealed longitudinal ulcers, ischemic colitis was diagnosed. We treated him conservatively at first, but when we found the ulceration of the sigmoid colon had penetrated the mesenterium, colectomy was indicated. After surgery, his general condition improved. Careful monitoring of complications related to HHS is important.

Epidemiology of Acute Kidney Injury in Moroccan Medical Intensive Care Patients: A Regional Prospective, Observational Study

“…[36] Rhabdomyolysis commonly occurred in patients with HHS, induces AKI and this could aggravate their clinical course and increase mortality. [37,38] In our study, 5 patients (8 %) presented AKI potentially drug-related. However, the kidneys are vulnerable to injury due to their high filtration capacity and high metabolic activity, and most drugs, especially hydrophilic drugs and their metabolites, are eliminated largely by kidneys in urine, thus increasing the risk of DIN.…”

Hyperglycemic Hyperosmolar Nonketotic Syndrome with Rhabdomyolysis in a Patient with Newly-Onset Diabetes: One Case Report and Literature Review

“…The mechanism of HHNS resulting in rhabdomyolysis is still not specific.The elevated blood glucose, sodium and urea in HHNS patients resulted in increase of the plasma osmolality, causing serious dehydration, hypovolemia and oxygen deficiency of local tissue [8,9]. As a consequence, the Na/K ATPase pump of skeletal muscle is destroyed, and the osmotic pressure imbalance inside and outside the skeletal muscle cells ultimately leads to the damage and dissolve of muscle cells.…”

A successfully treated case of hypopituitarism complicated with hyperosmolar hyperglycaemic state and rhabdomyolysis

“…This results in a fall in the transmembrane potential, thereby contributing to the development of rhabdomyolysis. 8 Hyperosmolar states may also elevate the intracellular calcium concentration. A persistently high intracellular calcium level may bring about the activation of neutral proteases and subsequent leakage of muscle enzymes.…”