Clinical and laboratory features of hyponatremia-induced myopathy

Abstract

The present findings indicate that hyponatremia infrequently causes skeletal muscle disruption, and that there are two types of hyponatremia-induced myopathy, acute onset and slowly progressive onset.

Asymptomatic elevation of creatine kinase in patients with hyponatremia

“…In a previous study, the slowly progressive muscle damage was only observed in the elderly subjects. 8 However, this may be a reflection that the elderly were more prone to developing hyponatremia and not necessarily a risk factor for hyponatremia-associated hyper-CKemia.…”

“…6,18 In one non-selective case series, the commonest cause of hyponatremia-associated hyper-CKemia was SIADH followed by primary polydipsia and congestive cardiac failure. 8 Although hyponatremiaassociated hyper-CKemia with water intoxication has been reported in several case reports, some of these presentations are confounded by the presence of coexisting causes of muscular injury such as seizures, intensive exercise and illicit drug use. 19,20 In comparison to others, the present study found a larger number of patients who had hyper-CKemia in the setting of diuretic-related hyponatremia.…”

“…6 However, several cases and cohort studies have reported other causes of hyponatremia associated with hyper-CKemia or myopathy including post-prostate surgery, acute adrenal insufficiency and syndrome of inappropriate anti-diuretic hormone (SIADH) secretion. [7][8][9][10] Severe skeletal muscle damage can lead to detrimental complications such as acute kidney injury (AKI) in 7-10% of cases, which can occur in both traumatic and non-traumatic causes. 11,12 Risk for developing AKI is higher when the CK level is above 15 000 IU/L but can occur at lower CK values when coexisting conditions such as sepsis or dehydration are present.…”

Addisonian crisis complicated by rhabdomyolysis and acute kidney injury

“…10 Hyponatremia due to water intoxication and SIADH is reported to cause rhabdomyolysis. 12,13 Many conditions are associated with rhabdomyolysis however it is rarely associated with the Addisonian crisis. Hyponatremia due to any cause can result in convulsions, which in turn may lead to muscle breakdown and ultimately renal failure.…”

Rhabdomyolysis in Acute Primary Adrenal Insufficiency Complicated by Severe Hyponatraemia

“…Rhabdomyolysis has been reported in the setting of other causes of hyponatraemia, such as water intoxication and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) (9,10). The degree of hyponatraemia has yet to be correlated with the incidence or severity of rhabdomyolysis.…”