Electromyographic and histological features of postpartum hypernatremic rhabdomyolysis

Naik, Karkal Ravishankar; Saroja, Aralikatte Onkarappa; Narayanappa, Gayatri

doi:10.4103/0972-2327.120485

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…Rhabdomyolysis can occur as a result of electrolyte abnormalities (hypokalemia, hypophosphatemia, hyponatremia, and hypernatremia) in the setting of endocrine diseases such as diabetes 60–63 , thyroid dysfunction 64, 65 , primary hyperaldosteronism 66 , primary adrenal insufficiency 67 , central diabetes insipidus 68 , postpartum hypernatremia 69 , and pituitary dysfunction 70 . Cases of rhabdomyolysis have also been attributed to electrolyte disturbances (primarily hypokalemia and hyponatremia) in the setting of laxative and diuretic misuse/abuse 71–73 .…”

Section: Acquired Causes Of Rhabdomyolysismentioning

confidence: 99%

Diagnostic evaluation of rhabdomyolysis

2015

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Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days following an inciting factor and may be associated with dark pigmentation of the urine. Serum creatine kinase and urine myoglobin levels are markedly elevated. The clinical examination, history, laboratory studies, muscle biopsy, and genetic testing are useful tools for diagnosis of rhabdomyolysis, and they can help differentiate acquired from inherited causes of rhabdomyolysis. Acquired causes include substance abuse, medication or toxic exposures, electrolyte abnormalities, endocrine disturbance, and autoimmune myopathies. Inherited predisposition to rhabdomyolysis can occur with disorders of glycogen metabolism, fatty acid beta-oxidation, and mitochondrial oxidative phosphorylation. Less common inherited causes of rhabdomyolysis include structural myopathies, channelopathies, and sickle cell disease. This review focuses on the differentiation of acquired and inherited causes of rhabdomyolysis and proposes a practical diagnostic algorithm.

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Section: Acquired Causes Of Rhabdomyolysismentioning

confidence: 99%

Diagnostic evaluation of rhabdomyolysis

2015

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“…From the past and our present case reports, hypernatremia‐associated myopathy mostly occurs in patients with hypothalamic lesions 8–10 . There have also been a few case reports regarding hypernatremia‐induced myopathy from other causes 11,12 . Thus, chronic and persistent hypernatremia, alone or together with hypothalamic dysfunction, may contribute to hypernatremia myopathy.…”

Section: Discussionmentioning

confidence: 53%

“…[8][9][10] There have also been a few case reports regarding hypernatremia-induced myopathy from other causes. 11,12 Thus, chronic and persistent hypernatremia, alone or together with hypothalamic dysfunction, may contribute to hypernatremia myopathy.…”

Section: Discussionmentioning

confidence: 99%

Hypothalamic hypernatremic myopathy: A single‐center case series

Bao

Liu

et al. 2023

Muscle and Nerve

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Introduction/Aims Hypernatremia myopathy is a rare disease often unrecognized by clinicians. This study aimed to present a case series of hypernatremic myopathy with an emphasis on profiling its clinical characteristics and exploring its pathogenesis. Methods We reviewed seven patients with hypernatremic myopathy and reported their demographic data, etiology, clinical manifestations, and laboratory and electrophysiological characteristics. A muscle biopsy was performed on one patient. Results All patients had hypothalamic lesions as the cause of the hypernatremia including craniopharyngioma, germinoma, pituitary adenoma, Langerhans cell histiocytosis, and glioma. The clinical manifestations varied from mild weakness to complete paralysis. Myalgia and muscle cramps were also observed. Four of the patients had rhabdomyolysis on admission and developed acute kidney injury. All patients had markedly elevated serum creatine kinase (CK) and sodium levels. There was a significant positive correlation between serum sodium and CK levels. A high prevalence of hypopituitarism in different axes was observed in our study. Central hypogonadism (5 of 7), central hypothyroidism (3 of 7), and central diabetes insipidus (3 of 7) were the most common manifestations of hypothalamic dysfunction. Myopathic changes were observed on needle electromyography. The muscle biopsy of one patient showed diffuse necrotic fibers and scattered hypercontracted fibers with increased ragged red fibers. Discussion Hypernatremia myopathy should be considered in hypernatremic patients with muscle weakness and myalgia. Rhabdomyolysis frequently occurs and may lead to acute kidney injury in hypernatremia myopathy. Testing of hormone levels and performance of brain magnetic resonance imaging for possible hypothalamic lesions is strongly recommended.

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“…La etiopatogenia de la rabdomiólisis se desconoce: se postula la presencia de un daño directo de las células musculares por la osmolaridad elevada (alteración de la bomba Na-K, aumento en el calcio intracelular y activación de proteólisis y apoptosis 12,15 ) o cambios bruscos en la osmolaridad que conlleven aumento del agua intracelular, edema celular y muerte. Se desconoce si la rabdiomiólisis secundaria a hipernatremia puede ser evitada con una corrección lenta (< 0,5 mEq/l/hora o 12 mEq/l/día), como ocurre con la mielinolisis cerebral pontina 16---18 .…”

Section: Discussionunclassified