Rare times rare: The hyponatremia, rhabdomyolysis, anterior compartment syndrome sequence

Dubin, Ina; Gelber, Moshe; Schattner, Ami

doi:10.1177/2054270416629326

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…Our findings are consistent with two previous observational studies suggesting rapid serum sodium correction is associated with rhabdomyolysis [ 7 , 8 ]. In addition, although rhabdomyolysis is a rare complication of hyponatremia according to previous case reports, rhabdomyolysis would be an under-recognized complication based on our results [ 5 , 12 ]. Previous studies have suggested that the incidence of rhabdomyolysis in water intoxication patients is approximately 30 to 55% [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 55%

Association between rapid serum sodium correction and rhabdomyolysis in water intoxication: a retrospective cohort study

2017

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BackgroundPatients with water intoxication may develop rhabdomyolysis. Existing studies suggest a relationship between the serum sodium correction rate and rhabdomyolysis. The aim of the present study was to determine the association between the sodium correction rate and rhabdomyolysis in patients with water intoxication.MethodsMedical records from all cases of water intoxication presenting to the emergency department and admitted to a single tertiary emergency hospital between September 2012 and August 2016 were examined retrospectively. Serum sodium correction rate was defined as the difference in serum sodium levels at admission and approximately 24 h after admission, divided by time. The primary outcome was rhabdomyolysis, defined as peak creatine kinase level ≥ 1500 IU/L. Logistic regression analysis was used to calculate the adjusted odds ratio of the serum sodium correction rate controlling for age, sex, convulsion, lying down for >8 h before admission to the emergency department, and serum sodium level on admission.ResultsA total of 56 cases of water intoxication were included in the study. The median serum sodium correction rate was 1.02 mEq/L/h, and 32 patients (62.5%) had rhabdomyolysis. Logistic regression analysis showed that serum sodium correction rate was an independent risk factor of rhabdomyolysis (adjusted odds ratio, 1.53 per 0.1 mEq/L/h; 95% confidence interval, 1.18–1.97).ConclusionsRapid correction of serum sodium was associated with rhabdomyolysis in patients with water intoxication. Therefore, strict control of serum sodium levels might be needed in such patients.

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Section: Discussionmentioning

confidence: 55%

Association between rapid serum sodium correction and rhabdomyolysis in water intoxication: a retrospective cohort study

2017

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“…Compartment syndrome isolated to the anterior compartment and from a medically induced aetiology is very rare. Our review found only five published cases [1][2][3][4][5]. Four cases were secondary to psychogenic polydipsia, and one case attributed to severe primary hypothyroidism and adrenal insufficiency.…”

Section: Discussionmentioning

confidence: 92%

“…All of the published cases similar to the one described in this case report resulted in permanent disability due to delays in recognising the diagnosis. Drop foot and loss of sensation in the dorsal foot is the likely outcome for a patient with delayed release of the anterior compartment [1,3,4]. This is due to necrosis of the muscles in the anterior compartment and/or compression of the deep peroneal nerve as it passes through the compartment, supplying the muscles before giving sensation to the 1st webspace on the dorsum of the foot.…”

Section: Discussionmentioning

confidence: 99%

Bilateral anterior compartment syndrome secondary to psychogenic polydipsia

et al. 2022

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Compartment syndrome is a surgical emergency requiring urgent release of the muscular compartments to prevent ischaemia and tissue death. Unusual presentation patterns or aetiological factors may be confusing, delaying the diagnosis and prompt management. We report a rare case of bilateral anterior compartment syndrome, secondary to psychogenic polydipsia. Compartment pressures were measured using a manometer. The patient was expedited to theatre for exploration. A literature review was performed to search for similar cases. In our case, a 42-year-old male presented confused and agitated with bilateral lower limb pain unresponsive to opiates. He had a past medical history of schizophrenia with psychogenic polydipsia, consuming 10 L of cola soft drink per day prior to presentation. Blood tests showed sodium of 112 mmol/L and a peak creatinine kinase of 13,417 U/L. On examination, he had tense and swollen bilateral anterior legs; posterior calves were soft. Left and right anterior compartment pressures were measured at 60 mmHg and 90 mmHg respectively (normal limit < 30 mmHg). At operation, bilateral fasciotomies of the anterior compartments were performed and bulging muscles were found. Reported cases similar to this resulted in permanent disability due to delays in recognising the diagnosis. Follow-up of this patient showed return of normal sensation and movement of the muscles of the anterior compartment. Hyponatraemia as a result of psychogenic polydipsia is well recognised, but isolated anterior compartment syndrome is a rare complication of hyponatraemia. This case report highlights the need to consider non-traumatic causes of compartment syndrome.Level of evidence: Level V, Diagnostic study

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“…There are many causes of hypotonic hyponatremia: primary polydipsia, syndrome of inappropriate antidiuretic hormone secretion (SIADH), renal failure, adrenal insufficiency, and heart failure. To differentiate between these causes, volume status, urine sodium, and urine osmolality need to be assessed [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Rhabdomyolysis in the Setting of Severe Hyponatremia: A Case Report

Mathew¹,

Chilakala²,

Elfert³

2023

Cureus

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Electrolyte imbalances are common problems among hospitalized patients, and they can have severe consequences. Although rare, severe hyponatremia or low sodium (Na) levels have been associated with the occurrence of rhabdomyolysis. This is a case of a 45-year-old man who presented with confusion and lethargy and was found to have severe hyponatremia with an elevated creatine phosphokinase (CPK) level of 45,440 IU/L. With the administration of normal saline, the Na levels and CPK improved. He was discharged from the hospital in stable clinical condition. This case demonstrates the need for providers to monitor rhabdomyolysis markers in severe hyponatremia, as there is an observed association between the two and the sequelae can be severe.

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Rare times rare: The hyponatremia, rhabdomyolysis, anterior compartment syndrome sequence

Cited by 8 publications

References 11 publications

Association between rapid serum sodium correction and rhabdomyolysis in water intoxication: a retrospective cohort study

Association between rapid serum sodium correction and rhabdomyolysis in water intoxication: a retrospective cohort study

Bilateral anterior compartment syndrome secondary to psychogenic polydipsia

Rhabdomyolysis in the Setting of Severe Hyponatremia: A Case Report

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