Hypernatremia-associated rhabdomyolysis in paediatric traumatic brain injury

Rhabdomyolysis, a rare condition in the paediatric population, is characterised by the release of intracellular components due to muscle damage. Although various aetiologies have been described, severe hypernatraemia is rarely recognised as a cause. We present a paediatric case of rhabdomyolysis associated with severe hypernatraemia secondary to traumatic brain injury (TBI). A male in early adolescence with severe TBI following a motorcycle accident developed severe hypernatraemia (168 mEq/L) during management in the intensive care unit with hypertonic solution. Creatine kinase levels were elevated up to 30 197 U/L, with transient acute kidney injury. Other causes of rhabdomyolysis were excluded. The patient recovered with conservative management without requiring dialysis. Severe hypernatraemia may be a risk factor for rhabdomyolysis in patients with TBI, potentially mediated by osmotic alterations and cellular damage. This case highlights the importance of monitoring renal function and creatine kinase levels in patients with TBI and electrolyte disturbance. This report underscores the need to consider hypernatraemia as a potential cause of rhabdomyolysis in paediatric patients with TBI. Vigilance and timely management are crucial for the prevention of complications.