Triple Electrolyte Disorder (Hypokalemia, Hypophosphatemia and Hypomagnesemia) - A Rare Cause of Rhabdomyolysis!

International Journal of Medical Science

© 2016 by SSRG - IJMS Journal

Volume 3 Issue 10

Year of Publication : 2016

Authors : Sangita D Kamath, Neeraj Jain and Ballamudi Srinivas Rao

10.14445/23939117/IJMS-V3I10P102

How to Cite?

Sangita D Kamath, Neeraj Jain and Ballamudi Srinivas Rao, "Triple Electrolyte Disorder (Hypokalemia, Hypophosphatemia and Hypomagnesemia) - A Rare Cause of Rhabdomyolysis!," SSRG International Journal of Medical Science, vol. 3,  no. 10, pp. 9-13, 2016. Crossref, https://doi.org/10.14445/23939117/IJMS-V3I10P102

Abstract:

The spectrum of rhabdomyolysis ranges from an asymptomatic illness with mild elevation in the creatine kinase level to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure and disseminated intravascular coagulation. Acute kidney injury (AKI) occurs in 33-50% of patients with rhabdomyolysis. Muscular trauma is the most common cause of rhabdomyolysis. Less common causes include muscle enzyme deficiencies, electrolyte abnormalities, infectious causes, drugs, toxins and endocrinopathies. Weakness, myalgia and teacoloured urine are the main clinical manifestations. The most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration to prevent renal failure. During rhabdomyolysis the injured muscle leaks potassium leading to hyperkalemia. Hyperkalemia also occurs due to renal failure and hence hypokalemia as a cause of rhabdomyolysis is usually missed. We report a rare case of rhabdomyolysis due to combined hypokalemia, hypophosphatemia and hypomagnesemia, who despite high elevations of creatine kinase escaped renal injury.

Keywords:

hypokalemia, hypophosphatemia, muscle pain, creatine kinase, rhabdomyolysis.

References:

[1] Poels P, Gabreels F. Rhabdomyolysis: A review of literature. Clin Neurol Neurosurg 1995, 95: 175-92.
[2] Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: Rhabdomyolysis – An overview for clinicians. Critical Care 2005, 9: 158-69. (DOI 10.1186/cc2978)
[3] Ali S, Taguchi A, Rosenberg H. Malignant hyperthermia. Best Pract Resp Clin Anaesthesiol 2003, 4: 519-33.
[4] Vanholder R, Sever MS, Erek E, Lameire N. Disease of the month – Rhabdomyolysis. J Am Soc Nephrol 2000, 11: 1553–61.
[5] Victor M. Toxic and nutritional myopathies. In Myology. Volume 2. Edited by Engel AG, Banker BQ. New York: McGraw- Hill; 1986:1807-42.
[6] Sauret J, Marinides G, Wang G: Rhabdomyolysis. Am Fam Physician 2002, 65: 907-12.
[7] Gabow P, Kaehny W, Kelleher S. The spectrum of rhabdomyolysis. Medicine 1982, 62: 141-52.
[8] Dayer-Berenson L. Rhabdomyolysis a comprehensive guide. ANNA J 1994, 21:15-18.
[9] Qtu LL, Nalin P, Huffman Q, Sneed JB, Renshaw S, Hartman SW. Nontraumatic Rhabdomyolysis with Long-Term Alcohol Intoxication. JABFP 2004,17: 54-58.
[10] Knochel JP, Schlein EM. On the mechanism of rhabdomyolysis in potassium depletion. J Clin Invest 1972, 51:1750.
[11] Zager RA. Rhabdomyolysis and myohemoglobinuric ARF. Kidney International 1996, 49: 314-26.
[12] Huang CL, Kuo E. Hypokalemia in Magnesium Deficiency. J Am Soc Nephrol 2007,18: 2649–52.
[13] 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.
[14] Malickova K, Merta M, Zabka J, Duskova J, Stejskalova A, Petrik R et al. Renal failure caused by rhabdomyolysis induced by hypokalemia in Conn's syndrome. Cas-Lek-Cesk 1996, 135(4):117- 19.
[15] Heidemann H, Kruezfelder E. Hypokalemic rhabdomyolysis with myoglobinuria due to licorice ingestion and diuretic treatment. Klin Wochenschr 1983, 61:303-05.
[16] Gunal A, Celiker H, Dogukan A, Ozalp G, Kirciman E, Simsekli H. Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes. J Am Soc Nephrol 2004,15:1862-67.