Rhabdomyolysis Induced Acute Kidney Injury in Hyperglycemic Hyperosmolar State Patient With New-Onset Diabetes: A Case Report

Abstract

The hyperglycemic hyperosmolar state (HHS) is a serious acute complication of type 2 diabetes mellitus that requires prompt recognition, diagnosis, and treatment. Reversible acute kidney injury is common in hyperglycemic states. However, hyperglycemic emergencies can contribute to the development of rhabdomyolysis, which can further aggravate acute kidney injury and can cause high morbidity and mortality. HHS can be the first clinical presentation of diabetes mellitus in some patients. Here, we present a case of HHS-related rhabdomyolysis and acute kidney injury, which was the first presentation of type 2 diabetes mellitus in this patient. Our case highlights the importance of a rare association between rhabdomyolysis and HHS in diabetic patients.

Hypernatremia in Hyperglycemia: Clinical Features and Relationship to Fractional Changes in Body Water and Monovalent Cations during Its Development

“…Fever and leukocytosis were reported in most patients on admission. Infections listed in the case reports included pneumonia [48,51,56,58,61,[70][71][72]74,82,88,97,113,116,117], urinary tract infection [62,70,74,104,108,119], bacteremia [27,69,100], pulmonary tuberculosis [40], acute parotitis [47], suppurative pancreatitis [50], infected varicose veins [60], decubitus infection [70], and gastroenteritis in children [75].…”

“…Severe complications of the hyperglycemic syndromes or of their treatment included rhabdomyolysis in 13 patients [84,85,87,[89][90][91][92][93]95,110,116,118,121]; osmotic myelinolysis in 11 patients [51,61,81,83,86,88,104,117]; arterial and/or venous clotting in vital organs or with adverse outcomes, e.g., leg or bowel gangrene, in 8 patients [27,77,78,100,103,108,119]; renal failure not completely recovered in 4 patients [38,50,77,87] and requiring short term dialysis by various methods in another 4 patients [89,90,98]; and one each with cerebral edema [73], pulmonary edema after saline infusion [82], profound hypokalemia (1.8 mmol/L) leading to fatal cardiac arrest [97], and parenchymal hemorrhages [98]. Again, several reports contained more than one case with the same complication.…”