Rhabdomyolysis in the hyperosmolal state

Area of Science:

• Endocrinology
• Nephrology
• Metabolic Disorders

Background:

• Hyperosmolar states, including diabetic ketoacidosis and hyperosmolar coma, present significant clinical challenges.
• Rhabdomyolysis, a condition involving muscle breakdown, can occur in various critical illnesses.

Purpose of the Study:

• To investigate the prevalence of rhabdomyolysis in patients experiencing hyperosmolar states.
• To compare the clinical and biochemical characteristics of patients with and without rhabdomyolysis in this context.

Main Methods:

• A retrospective review of 130 hospital admissions for diabetic ketoacidosis or hyperosmolar coma.
• Analysis of 31 patients in a hyperosmolar state, comparing those with (Group I) and without (Group II) biochemical evidence of rhabdomyolysis.

Main Results:

• Patients with rhabdomyolysis (Group I) exhibited significantly higher serum creatine phosphokinase (CPK) levels (7,156 IU/L vs. 61 IU/L) and serum osmolality (381 mOsm/kg vs. 324 mOsm/kg) compared to Group II.
• Elevated serum sodium levels were observed in Group I (151 mEq/L vs. 133 mEq/L), with a linear association between CPK and both serum sodium and osmolality.
• Group I patients had lower mean serum potassium levels, and fewer were hyperkalemic, despite muscle injury, hyperosmolality, hyperglycemia, and acidosis.

Conclusions:

• Subclinical rhabdomyolysis is a frequent complication in the hyperosmolar state.
• The absence of hyperkalemia in hyperosmolar patients with muscle injury suggests underlying total-body potassium depletion.
• Hypokalemia, in conjunction with the hyperosmolar state, appears to predispose individuals to developing rhabdomyolysis.