Hypokalemic rhabdomyolysis: an unusual presentation of Sjogren's syndrome

Chérif, E.; Hassine, L. Ben; Kéchaou, I.; Khalfallah, N.

doi:10.1136/bcr-2013-201345

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…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 . Rhabdomyolysis can be the presenting event in cases of inherited or acquired renal tubular dysfunction with profound hypokalemia, or it can be triggered by illness or discontinuation of medical treatment 74, 75 . These causes can be screened for with serum and urine electrolyte panels and studies of endocrine function.…”

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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“…However, a serum K + < 3 mEq/L is related to a total body deficit of > 200 mEq, which varies with weight [19]. Patients with SS and dRTA can present life-threatening complications owing to massive intracellular potassium depletion, including rhabdomyolysis, respiratory paralysis, or malignant arrhythmias [13, 14, 20, 21].…”

Section: Discussionmentioning

confidence: 99%

Distal renal tubular acidosis and severe hypokalemia: a case report and review of the literature

et al. 2019

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Background Distal renal tubular acidosis is a relatively infrequent condition with complex pathophysiology that can present with life-threatening electrolyte abnormalities. Case presentation We describe a case of a 57-year-old Caucasian woman with previous episodes of hypokalemia, severe muscle weakness, and fatigue. Upon further questioning, symptoms of dry eye and dry mouth became evident. Initial evaluation revealed hyperchloremic metabolic acidosis, severe hypokalemia, persistent alkaline urine, and a positive urinary anion gap, suggestive of distal renal tubular acidosis. Additional laboratory workup and renal biopsy led to the diagnosis of primary Sjögren’s syndrome with associated acute tubulointerstitial nephritis. After potassium and bicarbonate supplementation, immunomodulatory therapy with hydroxychloroquine, azathioprine, and prednisone was started. Nonetheless, her renal function failed to improve and remained steady with an estimated glomerular filtration rate of 42 ml/min/1.73 m 2 . The literature on this topic was reviewed. Conclusions Cases of renal tubular acidosis should be carefully evaluated to prevent adverse complications, uncover a potentially treatable condition, and prevent the progression to chronic kidney disease. Repeated episodes of unexplained hypokalemia could be an important clue for diagnosis.

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“…However, in our study, toluene intoxication diagnosis was established by a compatible clinical presentation and either the patients or relatives statement of intentional toluene inhalation. Besides toluene intoxication, other conditions may present with secondary RTA, hypokalemia and paralysis, such as Sjögren’s syndrome, hypothyroidism and systemic lupus erythematosus were discarded [ 15 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study

et al. 2015

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BackgroundToluene is one of the most widely abused inhaled drugs due to its acute neurologic effects including euphoria and subsequent depression. However, dangerous metabolic abnormalities are associated to acute toluene intoxication. It has been previously reported that rhabdomyolysis and acute hepatorenal injury could be hallmarks of the condition, and could constitute risk factors for poor outcomes. The objective was to describe the clinical presentation, to characterize the renal and liver abnormalities, the management and prognosis associated to acute toluene intoxication.MethodsWe prospectively assessed 20 patients that were admitted to a single center’s emergency department from September 2012 to June 2014 with clinical and metabolic alterations due to acute toluene intoxication.ResultsThe main clinical presentation consisted of weakness associated to severe hypokalemia and acidosis. Renal glomerular injury (proteinuria) is ubiquitous. Biliary tract injury (alkaline phosphatase and gamma-glutamyl transpeptidase elevations) disproportional to hepatocellular injury is common. Rhabdomyolysis occurred in 80 % of patients, probably due to hypokalemia and hypophosphatemia. There were three deaths, all female, and all associated with altered mental status, severe acidosis, hypokalemia and acute oliguric renal failure. The cause of death was in all cases due to cardiac rhythm abnormalities.ConclusionThe hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Liver injury and rhabdomyolysis are common. On admission, altered mental status, renal failure, severe acidemia and female gender (not significant in our study, but present in all three deaths) could be associated with a poor outcome, and patients with these characteristics should be considered to be treated in an intensive care unit.

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Hypokalemic rhabdomyolysis: an unusual presentation of Sjogren's syndrome

Cited by 6 publications

References 13 publications

Diagnostic evaluation of rhabdomyolysis

Diagnostic evaluation of rhabdomyolysis

Distal renal tubular acidosis and severe hypokalemia: a case report and review of the literature

Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study

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