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Reakes E, Drak D, Gracey D. A suspected case of hyponatraemia induced rhabdomyolysis: a case report. BMC Nephrol 2022; 23:180. [PMID: 35546656 PMCID: PMC9092814 DOI: 10.1186/s12882-022-02787-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/11/2022] [Indexed: 01/06/2023] Open
Abstract
Background Hyponatraemia is a documented but under-recognised cause of rhabdomyolysis, with the contrasting treatment strategies for the two conditions posing a unique challenge. Balancing the need for aggressive fluid replacement for the treatment of rhabdomyolysis, with the risk of rapidly correcting hyponatraemia is imperative. Case presentation A 52-year-old gentleman with a background of HIV infection and hypertension presented with seizures following methamphetamine use, acute water intoxication, and thiazide use. He was found to have severe hyponatraemia, and following initial correction with hypertonic saline, was commenced on a fluid restriction. After two days he developed abdominal wall and thigh pain, along with oliguria. Laboratory data demonstrated markedly elevated creatine kinase levels and deteriorating renal function. A diagnosis of rhabdomyolysis and severe acute kidney injury was made and aggressive fluid replacement commenced, leading to full resolution of the hyponatraemia, rhabdomyolysis and acute kidney injury. Conclusion Hyponatraemia-induced rhabdomyolysis is rare but can cause significant morbidity and mortality if left untreated. Physicians should consider measuring creatine kinase levels in all patients presenting with severe hyponatraemia, particularly in the presence of other risk factors for rhabdomyolysis. Fluid replacement strategies must be considered in relation to the relative onset and risk of over-correcting hyponatraemia.
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Affiliation(s)
- Edward Reakes
- Renal Unit, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia.
| | - Douglas Drak
- Wagga Wagga Base Hospital, Wagga Wagga, NSW, 2650, Australia.,Central Clinical School, University of Sydney, Camperdown, NSW, 2050, Australia
| | - David Gracey
- Renal Unit, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia.,Central Clinical School, University of Sydney, Camperdown, NSW, 2050, Australia
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2
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AlDhalaan W, Syed F, Javaid HA, AlSagheir A, Almustanyir S. A Rare Case of Adenosine Deaminase tRNA-Specific 3 Mutation, Adrenal Insufficiency, and Rhabdomyolysis. Cureus 2021; 13:e19833. [PMID: 34963848 PMCID: PMC8702390 DOI: 10.7759/cureus.19833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/05/2022] Open
Abstract
Adenosine deaminase t-RNA-specific 3 (ADAT3) gene, present on chromosome 19, encodes for an enzyme responsible for deamination of adenosine to inosine. Individuals with ADAT3 mutation display microcephaly, dysmorphic features, neurological, behavioural, and endocrinal pathologies. ADAT3 mutation is a recognized cause of intellectual disability (ID) in Saudi Arabia, particularly amongst consanguineous families. Adrenal insufficiency (AI) is a life-threatening condition with variable clinical signs and symptoms, such as fatigue, nausea, vomiting, hypotension, hypoglycemia, and electrolyte imbalances. One very uncommon presentation of acute AI is rhabdomyolysis, a syndrome characterized by markedly elevated creatinine kinase (CK) levels, myoglobinuria, and muscle pain. We describe a case of an eight-year-old boy with ADAT3 mutation and growth hormone (GH) deficiency presenting with AI and rhabdomyolysis.
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Affiliation(s)
| | | | | | - Afaf AlSagheir
- Pediatric Endocrinology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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3
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Fofi C, Maresca B, Altieri S, Menè P, Festuccia F. Renal involvement in adrenal insufficiency (Addison disease): can we always recognize it? Intern Emerg Med 2020; 15:23-31. [PMID: 31625077 DOI: 10.1007/s11739-019-02209-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/30/2019] [Indexed: 12/17/2022]
Abstract
Addison disease is due to the destruction or dysfunction of the entire adrenal cortex. Nowadays, the causes of adrenal insufficiency are autoimmune disease for 70-90% and tuberculosis for 7-20%. Many typical signs and symptoms, such as hyponatremia, hyperkalaemia, or renal insufficiency can represent the reasons for a nephrology consultation, especially in conditions of urgency, and they can easily be confused with other causes. Moreover, the fact that in a short time range we have diagnosed the three cases described as a guide in this review, has aroused our attention as nephrologists on a disease in which we have probably already encountered but without recognizing it. The blood tests showed in all three patients severe electrolyte disorders and acute renal failure which will be discussed in their physiopathogenetic mechanisms. In a peculiar way, these alterations were not controlled with repolarizing solutions, fluid replacement and increased volemia, but only after steroid administration. In conclusion, in this review all the known pathogenic mechanisms causing disorders of nephrological interest in adrenal insufficiency are discussed.
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Affiliation(s)
- Claudia Fofi
- Nephrology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, II Faculty of Medicine, "Sapienza" University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy.
| | - Barbara Maresca
- Nephrology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, II Faculty of Medicine, "Sapienza" University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy
| | - Silvia Altieri
- Nephrology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, II Faculty of Medicine, "Sapienza" University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy
| | - Paolo Menè
- Nephrology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, II Faculty of Medicine, "Sapienza" University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy
| | - Francescaromana Festuccia
- Nephrology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, II Faculty of Medicine, "Sapienza" University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy
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4
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Komatsu T, Ohara N, Hirota N, Yoneoka Y, Tani T, Terajima K, Ozawa T, Sone H. Isolated Adrenocorticotropic Hormone Deficiency Presenting with Severe Hyponatremia and Rhabdomyolysis: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1857-1863. [PMID: 31827062 PMCID: PMC6931390 DOI: 10.12659/ajcr.918427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/08/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Isolated adrenocorticotropic hormone deficiency (IAD) is a rare disorder characterized by central adrenal insufficiency (AI) but normal secretion of pituitary hormones other than adrenocorticotropic hormone. IAD usually presents with unspecific symptoms of AI, such as anorexia and fatigue, but some patients present with a variety of atypical manifestations. Rhabdomyolysis is a potentially life-threatening clinical syndrome caused by skeletal muscle injury with the release of muscle cell contents into the circulation. A wide variety of disorders can cause rhabdomyolysis. Herein, we report an unusual case of IAD presenting with hyponatremia and rhabdomyolysis. CASE REPORT A 67-year-old Japanese woman with a 2-month history of anorexia and fatigue was diagnosed with severe hyponatremia (serum sodium, 118 mEq/L) and rhabdomyolysis (serum creatine phosphokinase, 6968 IU/L), after 2 days of vomiting and muscle weakness. Physical and laboratory findings did not show dehydration or peripheral edema. Her rhabdomyolysis resolved with normalization of serum sodium levels during administration of sodium chloride. However, her anorexia and fatigue remained unresolved. After reducing the amount of sodium chloride administered, the patient still had hyponatremia. Detailed endocrinological examinations indicated IAD; her hyponatremia was associated with inappropriately high plasma arginine vasopressin levels. The patient received corticosteroid replacement therapy, which resolved her anorexia, fatigue, excessive arginine vasopressin, and hyponatremia. CONCLUSIONS This case highlights the importance of considering the possibility of central AI in patients with hyponatremia and excessive arginine vasopressin levels. In addition, rhabdomyolysis associated with hyponatremia can be an important manifestation of IAD.
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Affiliation(s)
- Takeshi Komatsu
- Department of Endocrinology and Metabolism, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan
| | - Nobumasa Ohara
- Department of Endocrinology and Metabolism, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan
| | - Naoko Hirota
- Department of Internal Medicine, Niigata Prefectural Tokamachi Hospital, Niigata City, Niigata, Japan
| | - Yuichiro Yoneoka
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan
| | - Takashi Tani
- Department of Neurology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan
| | - Kenshi Terajima
- Department of Neurology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan
| | - Tetsutaro Ozawa
- Department of Neurology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata City, Niigata, Japan
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Kolovou G, Cokkinos P, Bilianou H, Kolovou V, Katsiki N, Mavrogeni S. Non-traumatic and non-drug-induced rhabdomyolysis. Arch Med Sci Atheroscler Dis 2019; 4:e252-e263. [PMID: 32368681 PMCID: PMC7191942 DOI: 10.5114/amsad.2019.90152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/10/2019] [Indexed: 01/19/2023] Open
Abstract
Rhabdomyolysis (RM), a fortunately rare disease of the striated muscle cells, is a complication of non-traumatic (congenital (glycogen storage disease, discrete mitochondrial myopathies and various muscular dystrophies) or acquired (alcoholic myopathy, systemic diseases, arterial occlusion, viral illness or bacterial sepsis)) and traumatic conditions. Additionally, RM can occur in some individuals under specific circumstances such as toxic substance use and illicit drug abuse. Lipid-lowering drugs in particular are capable of causing RM. This comprehensive review will focus on non-traumatic and non-drug-induced RM. Moreover, the pathology of RM, its clinical manifestation and biochemical effects, and finally its management will be discussed.
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Affiliation(s)
- Genovefa Kolovou
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Philip Cokkinos
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Vana Kolovou
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
- Molecular Immunology Laboratory, Onassis Cardiac Surgery Center, Athens, Greece
| | - Niki Katsiki
- First Department of Internal Medicine, Division of Endocrinology-Metabolism, Diabetes Center, AHEPA University Hospital, Thessaloniki, Greece
| | - Sophie Mavrogeni
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
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6
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Kennedy L, Nagiah S. A case of severe rhabdomyolysis associated with secondary adrenal insufficiency and autoimmune hepatitis. BMJ Case Rep 2019; 12:12/3/e227343. [PMID: 30898957 PMCID: PMC6453326 DOI: 10.1136/bcr-2018-227343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Rhabdomyolysis is a serious and life-threatening condition which has many established causes including endocrine disturbances. Of those, thyroid, adrenal and pituitary deficiencies are the most commonly seen. Most cases of rhabdomyolysis with adrenal insufficiency that have been reported have been primary. Here, we report an encounter with a patient who presented with her second case of severe rhabdomyolysis in the setting of secondary adrenal insufficiency. The cause for corticotropic suppression was most likely autoimmune hypophysitis given the presence of other autoimmune comorbidities including a new diagnosis of autoimmune hepatitis. In addition to her case, we present a brief review of the literature pertaining to cases of rhabdomyolysis attributed to adrenal insufficiency.
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Affiliation(s)
- Lisa Kennedy
- General Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Sureshkumar Nagiah
- General Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
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7
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Rhabdomyolysis in a patient complicated with hypopituitarism and multiple organ dysfunction syndrome and the literature review. Am J Emerg Med 2018; 36:1723.e1-1723.e6. [PMID: 29910183 DOI: 10.1016/j.ajem.2018.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 06/06/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Muscular symptoms, including stiffness, myalgia, cramps, and fatigue, are present in the majority of the patients with hypopituitarism, adrenal insufficiency and hypothyroidism, but rhabdomyolysis, the rapid breakdown of skeletal muscle, is a rare manifestation. In most patients who develop rhabdomyolysis, precipitating factors, such as strenuous exercise or use of lipid-lowering drugs, can be identified. CASE REPORT We report the case of a 23-year-old male with primary hypopituitarism who developed acute renal impairment (AKI) with rhabdomyolysis after strenuous physical activity (push-ups). His blood test confirmed marked hypopituitarism. Severe elevation of serum CK consistent with rhabdomyolysis was noted and an elevated creatinine indicated AKI and multiple organ dysfunction syndrome (MODS). Patient's condition improved significantly after continuous renal replacement therapy (CRRT), glucocorticoid hormone replacement therapy and aggressive hydration. MODS with rhabdomyolysis in patients with hypothyroidism is quite rare and we expect that this case report adds to the existing literature on this subject. We also emphasize that thyroid and adrenal gland status should be evaluated in patients with unexplained AKI, MODS and presenting with the symptoms of muscle involvement. LITERATURE REVIEW We respectively reviewed 23 patients with hypopituitarism, adrenal Insufficiency and hypothyroidism induced rhabdomyolysis who were involved in the past 40 years relevant literatures. CONCLUSION We report a successfully treated case of rhabdomyolysis, which is a rare but potentially serious complication of hypopituitarism. Screening for endocrine abnormality in patients with elevated muscle enzymes should be considered, since an early diagnosis and prompt treatment is essential to prevent rhabdomyolysis and its consequences.
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8
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Dilrukshi MDSA, Sandakumari GVN, Abeysundara PK, Chang T. Craniopharyngioma presenting with severe hyponatremia, hyponatremia-induced myopathy, and panhypopituitarism: a case report. J Med Case Rep 2017; 11:31. [PMID: 28160775 PMCID: PMC5292142 DOI: 10.1186/s13256-017-1210-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 01/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background Craniopharyngiomas are rare intracranial tumors commonly presenting with neurological symptoms. Reports of severe hyponatremia as a presenting manifestation of a craniopharyngioma and hyponatremia-induced myopathy are rare. We report the case of a patient with craniopharyngioma presenting with severe hyponatremia, panhypopituitarism, and hyponatremia-induced myopathy. Case presentation A 52-year-old Sri Lankan man presented with anorexia, nausea, fatigue, generalized muscle weakness, and cramps for 1 week. The onset of his illness had been preceded by vomiting and diarrhea for 1 day which he attributed to food poisoning. On examination, he had an apathetic disposition with a generalized “sallow complexion.” He was not dehydrated. Apart from reduced muscle power (4/5) and hyporeflexia, the neurological examination was normal. His serum sodium was 102 mmol/l; potassium 4.1 mmol/l; chloride 63 mmol/l; plasma osmolality 272 mosm/KgH2O; urine osmolality 642 mosm/KgH2O; and urine sodium 79 mmol/l. His creatine phosphokinase was 12,400 U/l, lactate dehydrogenase 628 U/l, aspartate aminotransferase 360 U/l, and alanine aminotransferase 64 U/l. His hormone profile revealed panhypopituitarism. An electromyogram showed nonspecific abnormalities while a muscle biopsy did not show any pathology. Magnetic resonance imaging of his brain demonstrated a well-defined craniopharyngioma with suprasellar extension. His pituitary gland was compressed and the pituitary stalk was displaced by the tumor. He had marked improvement in muscle power and rapid reduction of serum creatine phosphokinase levels paralleling the correction of severe hyponatremia, even before the initiation of hormone replacement. Conclusions This case illustrates the rare presentation of severe hyponatremia and hyponatremia-induced myopathy in patients with craniopharyngioma, awareness of which would facilitate early appropriate investigations and treatment.
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Affiliation(s)
- M D S A Dilrukshi
- University Medical Unit, National Hospital of Sri Lanka, Colombo 10, Sri Lanka.
| | - G V N Sandakumari
- University Medical Unit, National Hospital of Sri Lanka, Colombo 10, Sri Lanka
| | - P K Abeysundara
- University Medical Unit, National Hospital of Sri Lanka, Colombo 10, Sri Lanka
| | - T Chang
- University Medical Unit, National Hospital of Sri Lanka, Colombo 10, Sri Lanka.,Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka
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9
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Fares AB, Santos RAD. Conduct protocol in emergency: Acute adrenal insufficiency. Rev Assoc Med Bras (1992) 2016; 62:728-734. [PMID: 27992012 DOI: 10.1590/1806-9282.62.08.728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/28/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction: Acute adrenal insufficiency or addisonian crisis is a rare comorbidity in emergency; however, if not properly diagnosed and treated, it may progress unfavorably. Objective: To alert all health professionals about the diagnosis and correct treatment of this complication. Method: We performed an extensive search of the medical literature using specific search tools, retrieving 20 articles on the topic. Results: Addisonian crisis is a difficult diagnosis due to the unspecificity of its signs and symptoms. Nevertheless, it can be suspected in patients who enter the emergency room with complaints of abdominal pain, hypotension unresponsive to volume or vasopressor agents, clouding, and torpor. This situation may be associated with symptoms suggestive of chronic adrenal insufficiency such as hyperpigmentation, salt craving, and association with autoimmune diseases such as vitiligo and Hashimoto's thyroiditis. Hemodynamically stable patients may undergo more accurate diagnostic methods to confirm or rule out addisonian crisis. Delay to perform diagnostic tests should be avoided, in any circumstances, and unstable patients should be immediately medicated with intravenous glucocorticoid, even before confirmatory tests. Conclusion: Acute adrenal insufficiency is a severe disease that is difficult to diagnose. It should be part of the differential diagnosis in cases of hypotensive patient who is unresponsive to vasoactive agents. Therefore, whenever this complication is considered, health professionals should aim specifically at this pathology.
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Affiliation(s)
- Adil Bachir Fares
- Medical Student, 6th year, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Rômulo Augusto Dos Santos
- Degree in Endocrinology and Metabology from Sociedade Brasileira de Endocrinologia e Metabologia (SBEM). Assistant Physician at the Internal Medicine Service of Hospital de Base. Researcher at Centro Integrado de Pesquisa (CIP), Hospital de Base, São José do Rio Preto. Endocrinology Coordinator of the Specialties Outpatient Clinic (AME), São José do Rio Preto, SP, Brazil
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10
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Martín-Campagne E, Ballester-Herrera MJ, Palomo-Atance E, Sánchez-Ruiz P, Giralt-Muiña P. Hyponatremic rhabdomyolysis in Addison's disease in a child with autoimmune polyglandular syndrome type 2. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2015; 62:511-512. [PMID: 26300496 DOI: 10.1016/j.endonu.2015.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/02/2015] [Accepted: 07/13/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Elena Martín-Campagne
- Unidad de Endocrinología Pediátrica, Servicio de Pediatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
| | - M José Ballester-Herrera
- Unidad de Endocrinología Pediátrica, Servicio de Pediatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Enrique Palomo-Atance
- Unidad de Endocrinología Pediátrica, Servicio de Pediatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Prado Sánchez-Ruiz
- Servicio de Pediatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Patricio Giralt-Muiña
- Unidad de Endocrinología Pediátrica, Servicio de Pediatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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11
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Tiniakou E, Mammen AL. Necrotizing myopathy caused by central hypothyroidism. Muscle Nerve 2015; 52:152-3. [PMID: 25808401 DOI: 10.1002/mus.24637] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Eleni Tiniakou
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew L Mammen
- National Institute of Musculoskeletal and Arthritis and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
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12
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Abstract
Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days after an inciting factor and may be associated with dark pigmentation of the urine. Serum creatine kinase and urine myoglobin levels are markedly elevated. Clinical examination, history, laboratory studies, muscle biopsy, and genetic testing are useful tools for diagnosis of rhabdomyolysis, and they can help differentiate acquired from inherited causes of rhabdomyolysis. Acquired causes include substance abuse, medication or toxic exposures, electrolyte abnormalities, endocrine disturbances, and autoimmune myopathies. Inherited predisposition to rhabdomyolysis can occur with disorders of glycogen metabolism, fatty acid β-oxidation, and mitochondrial oxidative phosphorylation. Less common inherited causes of rhabdomyolysis include structural myopathies, channelopathies, and sickle-cell disease. This review focuses on the differentiation of acquired and inherited causes of rhabdomyolysis and proposes a practical diagnostic algorithm. Muscle Nerve 51: 793-810, 2015.
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Affiliation(s)
- Jessica R Nance
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew L Mammen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 50, Room 1146, Bethesda, Maryland, 20892, USA
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13
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Khow KSF, Lau SY, Li JYZ, Yong TY. Asymptomatic elevation of creatine kinase in patients with hyponatremia. Ren Fail 2014; 36:908-11. [PMID: 24673369 DOI: 10.3109/0886022x.2014.900600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Elevated creatine kinase (hyper-CKemia) has been observed in small number of patients with hyponatremia. This study evaluated the features and outcomes of patients admitted with hyponatremia complicated by hyper-CKemia. Patients admitted with hyponatremia and concurrently found to have elevated creatine kinase (CK) of above 375 IU/L (male) or 225 IU/L (female), over a 5-year period were retrospectively reviewed. Those with myocardial injury (elevated CK-MB isoenzyme [CK-MB/CK percentage of >2.5%] or Troponin T [>0.02 μg/L]), traumatic or ischemic muscle damage, primary myopathic disorder, seizures prior to CK measurement or those taking medications which can cause myopathy, were excluded. Thirty-two patients with hyponatremia and hyper-CKemia were identified. All patients had no muscular symptoms or weakness. The commonest cause of hyponatremia in this cohort was related to diuretics (50%). The mean sodium level on presentation was 116.0 ± 6.9 mmol/L and the median peak CK was 895.5 (interquartile range: 610.8-1691.8) IU/L. Six (18%) patients developed acute kidney injury (AKI). The length of hospital admission of the entire cohort was 8.0 ± 5.8 days. Patients with hyper-CKemia in the setting of diuretic-associated hyponatremia were older and had longer hospital length of stay compared with primary-polydipsia-associated. Asymptomatic hyper-CKemia is an uncommon association with hyponatremia of various etiologies. Hyponatremia-associated hyper-CKemia can be complicated by AKI.
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Affiliation(s)
- Kareeann S F Khow
- Department of General Medicine, Flinders Medical Centre , Adelaide , Australia
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