Title: Severe Hypokalemic Rhabdomyolysis- A Report of Two Cases
Authors: Ganesh K M, Pooja P S, Chandan G S, Padmakumar A V, Aashish Parekh
DOI: https://dx.doi.org/10.18535/jmscr/v8i7.04
Abstract
Introduction
Rhabdomyolysis- the dissolution of striped skeletal muscle is characterized by the leakage of muscle cell contents1. Acute kidney injury is a potential complication of severe rhabdomyolysis and carries a poor prognosis.
The common etiologies for rhabdomyolysis are trauma and direct compression but can also be due to non traumatic causes like seizures heat stroke and extreme exercise,drugs, toxins, infections, endocrinopathies, stings of insects and electrolyte disturbances-hypokalemia, hypocalciemia hypophosphatemia1.
Though hypokalemia is very common medical problem, but it is rarely a cause of rhadomyolysis attributing to only 14-28% of cases2. The mechanism of which is also not well understood. Also, hypokalemia may go unrecognized in the case of rhabdomyolysis due to the release of potassium from damaged muscle into circulation. We present 2 cases of hypokalemia induced rhabdomyolysis.
Case 1
A 83 year old male presented with two days history of fever with vomiting for which he took antibiotics and later developed multiple episodes of loose stools following that. He developed slurring of speech and generalized weakness for which he was admitted in a peripheral centre and after initial evaluation he was found to be hypokalemic with a serum potassium of 1.8Meq/l. He was a known case of hypertension on regular medications .On admission at our centre he had an episode of vomiting following which his airway was secured to prevent aspiration. He was hemodynamically unstable requiring vasopressor support.
References
- Curry SC, Chang D, Conner D. Drug-and toxin-induced rhabdomyolysis. Ann Emerg Med 1989; 18: 1066-84.
- Antoniadis DJ, Vavouranakis EM, Tsioufis KP, Toutouzas PK. Rhabdomyolysis due to diuretic treatment. Hellenic J Cardiol 2003;44:80-2
- Xavier Bosch, M.D., Ph.D., Esteban Poch, M.D., Ph.D., and Josep M. Grau, M.D., Ph.D .N Engl J Med 2009; 361:62-72.
- Knochel JP. Rhabdomyolysis and myo-globinuria. Annu Rev Med 1982;33:435-43.
- Zager RA, Burkhast KM, Conrad DS, Gmur DJ. Iron, heme oxygenase, and glutathione: effects on myohemoglobinuric proximal tubular injury. Kidney Int 1995;48:1624-34.
- Hanip MR, Cheong IK, Chin GL,Khalid BA. Rhabdomyolysis associated with hypokalemic periodic paralysis of renal tubular acidosis.Singapore Med J 1990; 31(2):159-61.
- Malickova K, Merta M, Zabka J, et al. Renal failure caused by rhabdomyolysis induced by hypokalemia in Conn's syndrome. Cas-Lek-Cesk 1996;135(4): 117-9.
- Knochel JP, Schlein EM. On the mechanism of rhabdomyolysis in potassium depletion. J Clin Invest 1972;5:1750-8.