Rhabdomyolysis-Induced Acute Kidney Injury in Diabetic Emergency: Underdiagnosed and an Important Association to Be Aware of

Abstract

Rhabdomyolysis is a potentially life-threatening clinical syndrome associated with muscle injury which can cause a leakage of intracellular contents, manifested from the range of being asymptomatic to a life-threatening condition causing acute kidney injury and severe electrolyte abnormalities. Rhabdomyolysis has been associated with both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome, though there is an increased association with rhabdomyolysis and acute kidney injury with hyperosmolar nonketonic state compared with patients with diabetic ketoacidosis. Common clinical manifestations are muscle pain, dark urine, and generalized weakness. The causes of rhabdomyolysis are broadly categorized into three groups: traumatic, nontraumatic exertional, and nontraumatic nonexertional. Here, we present a case of rhabdomyolysis-induced acute kidney injury in a patient with hyperosmolar hyperglycemic state. The patient was discharged on insulin and needed intermittent dialysis for two months. Our case highlights the importance of the rare association of rhabdomyolysis causing acute kidney injury in a diabetic emergency.

Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study

“…With its limitations we adjusted for a comorbidity score to account for underlying conditions. In patients with hyperglycemic crises, we could speculate that additional factors could increase the risk of AKI and poor outcomes, including the severity of ketosis, hyperglycemia, dehydration, or rhabdomyolysis (37)(38)(39). Not surprisingly, our cohort showed increased mortality among those with worsening kidney function.…”

Rhabdomyolysis and Acute Pancreatitis in Diabetic Ketoacidosis: A Case Report and Review of Literature

“…Diabetic ketoacidosis (DKA) can be life-threatening in patients with uncontrolled Diabetes Mellitus (DM) especially in patients with type II Diabetes Mellitus. Acute pancreatitis (AP) and non-traumatic rhabdomyolysis can occur in severe cases of DKA which can increase the mortality if left undetected [1]. Rhabdomyolysis is a syndrome characterized by myonecrosis and the release of intracellular muscle constituents i.e.…”

“…Rhabdomyolysis is a syndrome characterized by myonecrosis and the release of intracellular muscle constituents i.e. Creatinine Kinase (CK) enzymes and myoglobin into the circulation [1]. The severity ranges from asymptomatic cases to life-threatening manifestations associated with extreme enzyme elevations, electrolyte imbalances, and acute kidney injury [1].…”

“…Creatinine Kinase (CK) enzymes and myoglobin into the circulation [1]. The severity ranges from asymptomatic cases to life-threatening manifestations associated with extreme enzyme elevations, electrolyte imbalances, and acute kidney injury [1]. Common clinical symptoms are muscle pain, dark urine, and generalized weakness.…”

“…Common clinical symptoms are muscle pain, dark urine, and generalized weakness. Rhabdomyolysis is classified into three groups: 1) traumatic; 2) non-traumatic exertional; and 3) non-traumatic non-exertional [1]. Although the exact mechanism of action of a hyperosmolar state causing rhabdomyolysis remains unclear, there have been theories postulating the etiology.…”