Rhabdomyolysis in the hyperosmolal state

Singhal, Pravin C.; Abramovici, Mirel; Venkatesan, J.

doi:10.1016/0002-9343(90)90120-3

Cited by 107 publications

(31 citation statements)

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“…This is especially important as the clinical manifestations are mild or absent. 1 Singhal et al found that more than 50% (16/31) of his patients admitted with the hyperosmolar state developed rhabdomyolysis. 1 The clinical concern is whether renal failure is more or less common in HONK associated rhabdomyolysis and whether it is possible to predict which patients will progress to acute renal failure.…”

Section: Commentmentioning

confidence: 98%

“…1 Singhal et al found that more than 50% (16/31) of his patients admitted with the hyperosmolar state developed rhabdomyolysis. 1 The clinical concern is whether renal failure is more or less common in HONK associated rhabdomyolysis and whether it is possible to predict which patients will progress to acute renal failure. For this a comparison of the clinical characteristics of rhabdomyolysis patients associated with HONK with or without acute renal failure will be required.…”

Section: Commentmentioning

confidence: 98%

“…2 Total body potassium deficiency, a frequent complication of hyperosmolar states, and pre-existent hypophosphataemia may be masked because of release of potassium and phosphate ions from damaged muscles. 1 The combination of all the above factors is likely to predispose to the development of rhabdomyolysis. 1 It is important to remember that subclinical rhabdomyolysis is a more common complication of the hyperosmolar state than is generally appreciated.…”

Section: Commentmentioning

confidence: 99%

“…1 The combination of all the above factors is likely to predispose to the development of rhabdomyolysis. 1 It is important to remember that subclinical rhabdomyolysis is a more common complication of the hyperosmolar state than is generally appreciated. This is especially important as the clinical manifestations are mild or absent.…”

Section: Commentmentioning

confidence: 99%

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Nontraumatic rhabdomyolysis: an unusual complication of diabetic hyperosmolar nonketotic (HONK) state

Gangopadhyay¹,

Ryder

2006

Journal of the Royal Society of Medicine

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Rhabdomyolysis is an uncommon but underestimated complication of HONK. 1 We present the case of a patient presenting with HONK complicated by rhabdomyolysis. CASE HISTORYA 75-year-old man of Asian origin was admitted with a 2-day history of being generally unwell. He noted progressive polyuria, polydipsia for about 2 months prior to admission. There was no history of trauma, seizures, muscle pain, chest pain, drug or alcohol abuse. He had no past medical history including no known diabetes mellitus. He was a non-smoker and did not drink alcohol.On admission his blood pressure was 150/90, pulse rate 110/minute regular, temperature 368C. Physical examination was only remarkable for dehydration. Laboratory investigations on admission revealed venous plasma glucose 42 mmol/L; sodium 152 mmol/L; potassium 4.4 mmol/ L; urea 13.4 mmol/L; creatine 147 mmol/L; arterial blood gas ph 7.36, HCO 3 23.9 mmol/L; serum osmolality 362 mOsm/kg; serum creatine kinase 6309 iu/L with CKMB fraction of 0.9%; troponin I 50.1 ng/L; albumin 50 g/L; bilirubin 12 mmol/L; alanine transferase 60 iu/L; alkaline phosphatase 127 iu/L; serum amylase 75 iu/L; haemoglobin 16.8 g/L; leucocytes 17610 9 platelets 267610 9 ; C-reactive protein 8 mg/L; erythrocyte sedimentation rate 16 mm in the first hour; urine dipstix revealed 4+ glucose; the chest X-ray and electrocardiograph were unremarkable.The patient was treated with rehydration and continuous insulin infusion for 48 h. The creatine kinase rose from 6309 iu/L on admission to a peak level of 11 275 iu/L on day 2 before reducing to 3292 iu/L on day 3. By day 3 his sodium had normalized to 137 mmol/L and creatine to 74 mmol/L. Blood and urine cultures were negative. The patient was feeling much better by day 2 when he was put on a twice-daily insulin regime. Due to important commitments at home the patient had to be discharged on day 3.

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Section: Commentmentioning

confidence: 98%

Section: Commentmentioning

confidence: 98%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

See 2 more Smart Citations

Nontraumatic rhabdomyolysis: an unusual complication of diabetic hyperosmolar nonketotic (HONK) state

Gangopadhyay¹,

Ryder

2006

Journal of the Royal Society of Medicine

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“…There are few reported cases in literature which had rhabdomyolysis in DKA. There may be no symptoms or the condition can present with a mild increase of creatine kinase or rarely significant acute renal failure necessitating hemodialysis [202][203][204][205].…”

Section: Rhabdomyolysis and Renal Failurementioning

confidence: 99%