Severe Hyponatremia After Water Intoxication: A Potential Cause of Rhabdomyolysis

Addisonian crisis complicated by rhabdomyolysis and acute kidney injury

“…This leads to increased intracellular calcium levels because of reduced extracellular sodium to be exchanged causing the cell death by the release of lipase and proteases. [7][8][9] Rhabdomyolysis is a syndrome characterized by muscle necrosis leading to the release of intracellular constituents into the circulation. The severity of disease ranges from asymptomatic serum elevation of muscle enzymes to lifethreatening disease associated with electrolyte imbalances and acute kidney injury.…”

Asymptomatic elevation of creatine kinase in patients with hyponatremia

“…5 Another possible mechanism is through the activation of sodium-calcium exchange which causes an increase in intracellular calcium. 24 When intracellular calcium ions reach a critical concentration, they activate neutral proteases and lipases that can destroy muscle cells. 25 Past reports have suggested that the elevated CK may be related to the rapid correction rate of hyponatremia.…”

Rhabdomyolysis in Acute Primary Adrenal Insufficiency Complicated by Severe Hyponatraemia

“…One possible mechanism is muscle cell lysis resulting from cellular oedema caused by the diffusion of water across the cell membrane as the extracellular fluid osmolality falls (12). Another postulated mechanism is the activation of Na/Ca exchange, causing an increase in intracellular calcium, which in turn leads to disruption of the skeletal muscle (13). Seizures as a result of hyponatraemia can cause muscle damage and a rise in the CK level, but seizure activity was only present in one of the cases, and was not present in our case (7).…”