Rhabdomyolysis in Diabetic Ketoacidosis

Koh, Chan-Young; Cowley, David; Savage, M O

doi:10.1001/archpedi.1981.02130350075030

Arch Pediatr Adolesc Med

1981

DOI: 10.1001/archpedi.1981.02130350075030

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Rhabdomyolysis in Diabetic Ketoacidosis

Chan-Young Koh¹,

David Cowley²,

M O Savage³

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“…Nontraumatic rhabdomyolysis during diabetic ketoacidosis complicated with anuria or acute renal failure has been described earlier in only 4 case reports [1][2][3][4]. However, the findings by other investigators of elevated serum activity of creatine phosphokinase and the observation of a positive urine test for haemoglobin in the absence of haematuria may indicate that damage to striated muscle cells with hypermyoglobinaemia and myoglobinuria accompanying diabetic ketoacidosis may be more frequent than previously recognized [5][6][7].…”

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confidence: 99%

Nontraumatic rhabdomyolysis during diabetic ketoacidosis

Møller-Petersen

Pt²,

Hjörne

et al. 1986

Diabetologia

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Summary. The frequency of nontraumatic rhabdomyolysis in diabetic ketoacidosis was investigated by serial measurements of the serum levels of myoglobin and the serum activity of creatine kinase isoenzyme MM in 12 consecutively admitted ketoacidotic patients. In 5 patients (Group 1) we found hypermyoglobinaemia and elevated activity of creatine kinase isoenzyme MM on admission to hospital, whereas these two variables were normal in 7 patients (Group 2). On admission significantly higher median blood glucose levels and higher median serum osmolality were found in Group 1 than in Group 2 (for blood glucose: 49.6 mmol/1 versus 19.0 mmol/1, p<0.02; for serum osmolality: 360mosm/kg H20 versus 315 mosm/kg H20, p <0.05). Decreased renal function was found in Group 1 as reflected by significantly higher betarmicroglobulin serum concentrations in Group 1 compared with Group 2 on admission (median values 4.1 mg/1 versus 1.7 mg/1, p < 0.01) and during the first 3 days of therapy. The serum concentration of hypoxanthine (an indicator of the cellular energy state) was elevated in all patients on admission, with no difference between patients with or without hypermyoglobinaemia. In conclusion, our findings suggest that nontraumatic rhabdomyolysis with hypermyoglobinaemia and elevated serum activity of creatine kinase isoenzyme MM may be a hitherto unrecognized common feature of diabetic ketoacidosis.

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mentioning

confidence: 99%

Nontraumatic rhabdomyolysis during diabetic ketoacidosis

Møller-Petersen

Pt²,

Hjörne

et al. 1986

Diabetologia

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Fatal Malignant Hyperthermia-Like Syndrome With Rhabdomyolysis Complicating the Presentation of Diabetes Mellitus in Adolescent Males

et al. 2003

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The underlying etiology of this syndrome remains unclear. Possibilities include an underlying metabolic disorder such as a fatty acid oxidation defect, an unrecognized infection, exposure to an unknown toxin, or a genetic predisposition to malignant hyperthermia. Evaluation for all these possibilities and empiric treatment with dantrolene should be considered for this type of patient until this syndrome is better characterized.

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Rare complications of pediatric diabetic ketoacidosis

Bialo

Agrawal

Boney

et al. 2015

WJD

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The incidence of type 1 diabetes (T1D) among youth is steadily increasing across the world. Up to a third of pediatric patients with T1D present with diabetic ketoacidosis, a diagnosis that continues to be the leading cause of death in this population. Cerebral edema is the most common rare complication of diabetic ketoacidosis in children. Accordingly, treatment and outcome measures of cerebral edema are vastly researched and the pathophysiology is recently the subject of much debate. Nevertheless, cerebral edema is not the only sequela of diabetic ketoacidosis that warrants close monitoring. The medical literature details various other complications in children with diabetic ketoacidosis, including hypercoagulability leading to stroke and deep vein thrombosis, rhabdomyolysis, pulmonary and gastrointestinal complications, and long-term memory dysfunction. We review the pathophysiology, reported cases, management, and outcomes of each of these rare complications in children. As the incidence of T1D continues to rise, practitioners will care for an increasing number of pediatric patients with diabetic ketoacidosis and should be aware of the various systems that may be affected in both the acute and chronic setting.

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Rhabdomyolysis in Diabetic Ketoacidosis

Cited by 3 publications

References 0 publications

Nontraumatic rhabdomyolysis during diabetic ketoacidosis

Nontraumatic rhabdomyolysis during diabetic ketoacidosis

Fatal Malignant Hyperthermia-Like Syndrome With Rhabdomyolysis Complicating the Presentation of Diabetes Mellitus in Adolescent Males

Rare complications of pediatric diabetic ketoacidosis

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