Two cases of hypokalaemic rhabdomyolysis: same but different

Pecnik, Philipp; Müller, P; Vrabel, Sybille; Windpessl, Martin

doi:10.1136/bcr-2017-223609

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…An additional anomaly of our patient’s presentation is the presence of rhabdomyolysis. We hypothesize that this was hypokalemic rhabdomyolysis secondary to GS [ 13 , 14 ]. Potassium is required for regional vasodilation during muscle activity [ 13 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Gitelman Syndrome Manifesting With Acute Hypokalemic Paralysis: A Case Report

Gunde,

CA,

Bhat

et al. 2023

Cureus

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Gitelman syndrome (GS) is a rare renal tubulopathy, classically characterized by renal salt wasting and metabolic alkalosis. It is usually an incidental diagnosis, being asymptomatic or with mild symptoms. GS manifesting with acute flaccid paralysis is extremely uncommon. We report a case of GS that mimicked Guillain-Barré syndrome (GBS), manifesting with acute hypokalemic paralysis. A middle-aged male with no known comorbidities presented to our center with paresthesias of all four limbs for one month and progressive, asymmetric limb weakness over the past eight days. Neurological examination revealed hypotonia, global areflexia, and power ranging from 3/5 to 4/5 in all four limbs, leading to our initial clinical diagnosis of GBS. Our patient’s laboratory panel revealed hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalcemia, characteristic of GS. Additionally, he had significantly elevated creatine phosphokinase, suggestive of rhabdomyolysis. Further urine studies revealed renal potassium wasting, confirming the diagnosis of GS. Whole exome genome sequencing for common causative genes and workup for autoimmune disease were both negative. With gradual electrolyte correction, the patient rapidly improved symptomatically. Our case highlights an uncommon initial presentation of GS and emphasizes the need for more literature on its manifestations from the Indian subcontinent.

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Section: Discussionmentioning

confidence: 99%

Gitelman Syndrome Manifesting With Acute Hypokalemic Paralysis: A Case Report

Gunde,

CA,

Bhat

et al. 2023

Cureus

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“…These finding might indicate that the use of thiazide and loop diuretics are important risk factors for severe hypokalemia-induced rhabdomyolysis in PA patients and result in their mechanism of potassium expulsion. It also indicates that the easily misdiagnosis when rhabdomyolysis and severe hypokalemia are the first manifestations in PA patients [ 8 , 9 ]. In our cases, we first only treated their rhabdomyolysis and hypokalemia.…”

Section: Discussionmentioning

confidence: 99%

“…Rhabdomyolysis induced by severe hypokalemia is a rare manifestation of PA. There were only a few cases presented in the English literature over the last 4 decades [ 2 – 9 ]. Here, we present 2 cases of severe hypokalemia-induced rhabdomyolysis caused by adrenal tumor-related primary aldosteronism.…”

Section: Introductionmentioning

confidence: 99%

Hypokalemia-Induced Rhabdomyolysis Caused by Adrenal Tumor-Related Primary Aldosteronism: A Report of 2 Cases

2021

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Case series Patients: Male, 53-year-old • Male, 46-year-old Final Diagnosis: Primary aldosteronism Symptoms: Myalgia • weakness Medication: — Clinical Procedure: Adrenalectomy Specialty: Endocrinology and Metabolic • Urology Objective: Unusual clinical course Background: Primary aldosteronism, also known as Conn’s syndrome, is a clinical condition caused by excessive production of aldosterone. The classic presenting signs of primary aldosteronism are hypertension and hypokalemia. However, rhabdomyolysis induced by severe hypokalemia is a rare manifestation of primary aldosteronism. There were only a few cases presented in the English literature over the last 4 decades. Case Report: We present 2 cases, a 53-year-old man and a 46-year-old man, with severe hypokalemia-induced rhabdomyolysis caused by adrenal tumor-related primary aldosteronism. Both of these patients were under medical treatment with oral anti-hypertension drug for hypertension, but were poorly controlled. They both presented to the Emergency Department with muscle weakness and pain. Laboratory testing showed elevated creatinine phosphokinase (CPK) and low serum potassium levels. Hypokalemia-induced rhabdomyolysis was suspected. A further endocrine survey showed low PRA (plasma renin activity) and high aldosterone levels, finding which are compatible with primary aldosteronism. Computed tomography (CT) was arranged for further evaluation, and adrenal tumors were found in both cases. Both patients underwent robotic-assisted laparoscopic adrenal-ectomy. In both cases, there was no recurrence of hypokalemia without potassium supplementation, and their hypertension was under better control at further follow-up visits. Conclusions: Hypokalemic rhabdomyolysis is a rare manifestation of primary aldosteronism. It might be difficult to making a diagnosis when rhabdomyolysis and severe hypokalemia are the first manifestations in patients with primary aldosteronism. The use of diuretics for hypertension treatment might be a risk factor for extremely low potassium levels, which can induce rhabdomyolysis in patients with primary aldosteronism.

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“…Rhabdomyolysis is a relatively rare but potentially lethal condition. Hypokalemia is a common electrolyte disorder and an established cause of rhabdomyolysis[1]. Frequent causes of hypokalemia are intestinal and urinary potassium loss through diarrhea or the use of diuretics.…”

Section: Introductionmentioning

confidence: 99%

Liquorice-induced severe hypokalemic rhabdomyolysis with Gitelman syndrome and diabetes: A case report

Yang¹,

Yin²,

Yang³

et al. 2019

WJCC

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BACKGROUND Licorice-induced severe hypokalemic rhabdomyolysis is clinically rare. Gitelman syndrome (GS) is the most common inherited renal tubular disease, while diabetes is one of the most prevalent diseases in the world. Recently, some studies have found that GS patients had higher diabetic morbidity. However, the coexistence of these three diseases has yet to be reported. CASE SUMMARY We report the case of a 62-year-old Chinese man who was admitted with weakness in the extremities, muscle pain, and dark-colored urine. He had consumed liquorice water daily for seven days prior to admission. The laboratory tests revealed a serum potassium level of 1.84 mmol/L, magnesium 0.68 mmol/L, creatinine phosphokinase (CK) 10117 IU/L, and marked hemoglobinuria. Fractional chloride excretion and fractional magnesium excretion were increased. Plasma renin activity and aldosterone concentration were within the normal ranges. Sequence analysis of the SLC12A3 gene revealed that he had compound heterozygous mutations. The diagnosis of liquorice-induced severe hypokalemic rhabdomyolysis with GS and diabetes was thus genetically confirmed. Serum potassium and CK quickly improved with potassium replacement therapy, hydration, and discontinuation of liquorice ingestion. Upon follow-up at 3 mo, the levels of CK, myoglobin, and potassium remained normal, and magnesium was above 0.6 mmol/L. CONCLUSION This case emphasizes that liquorice consumption and GS should be considered causes of hypokalemia and that the diabetic status of GS patients should be noted in the clinic.

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Two cases of hypokalaemic rhabdomyolysis: same but different

Cited by 5 publications

References 16 publications

Gitelman Syndrome Manifesting With Acute Hypokalemic Paralysis: A Case Report

Gitelman Syndrome Manifesting With Acute Hypokalemic Paralysis: A Case Report

Hypokalemia-Induced Rhabdomyolysis Caused by Adrenal Tumor-Related Primary Aldosteronism: A Report of 2 Cases

Liquorice-induced severe hypokalemic rhabdomyolysis with Gitelman syndrome and diabetes: A case report

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