Hyperosmolal State Associated with Rhabdomyolysis

Abstract

We report a case of nonketotic hyperosmolal state associated with rhabdomyolysis. None of the known predisposing factors for rhabdomyolysis, e.g. coma, potassium or phosphate depletion, were present in this patient. We propose that severe hyperosmolality per se may represent another predisposing factor for nontraumatic rhabdomyolysis.

Hypernatremia Associated with Severe Rhabdomyolysis

“…In another report rhabdomyolysis has been related to a nonketotic hyperosmolal state with hypernatremia [4], We have recently seen a case supporting a role of hyper natremia in the development of rhabdomyolysis.…”

“…It has been proposed [1,6] that hypernatremia and hyperosmolality may contribute to the development of rhabdomyolysis by decreasing the extrusion of sodium ions from muscle cells through the inhibition of the electrogenic sodium pump: this in turn would result in a fall of the transmembrane potential [4], Recent informa tion suggests that inhibition of sodium pump and depres sion of membrane potential could well set the stage for irreversible cellular injury by impairing the normal ex change of extracellular sodium for intracellular calcium, thus allowing a rise of the cytoplasmic calcium. If calciom ions attain a critical elevated value in the sarco plasm, neutral proteases are activated with consequential destruction of muscle cells [1,6].…”

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

“…The electrogenic sodium pump is inhibited by hyperosmolar states, acidosis, hypernatremia, and potassium deficiency, as well as by decreases in intramuscular energy supply due to insulin deficiency. 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 level.…”

How do I Diagnose and Manage Acute Endocrine Emergencies in the ICU?

“…4 Complications Subclinical rhabdomyolysis is a common finding in patients with HHS and elevated levels of creatinine kinase correlate with increasing osmolality. 37 HHS-induced rhabdomyolysis may contribute to acute renal failure and has been associated with a malignant hyperthermia-like syndrome. [38][39][40] Although the pathophysiology is unclear, hypophosphatemia has been implicated in the development of rhabdomyolysis.…”