[A case of severe hypernatremia complicated with rhabdomyolysis]

We report a 45-year-old male patient with severe hypernatremia followed by rhabdomyolysis and acute renal failure. He had developed hypernatremia for two years after a surgery for an intraventricular AVM involving the hypothalamic area, which was fed by the anterior cerebral artery. He was admitted to our hospital because of progressive muscle weakness. Because of loss of water intake due to impaired thirst sensation, he developed severe hypernatremia (191mEq/l) and marked rhabdomyolysis (CK 17,772 IU/l). He was treated with fluid supplement and hemodialysis for acute renal insufficiency. He had no thirst feeling. Blood studies revealed hyporeactivity to ADH in spite of marked hypernatremia and hyperosmorality. Therefore his condition was considered as adipsic hypernatremia. We concluded that rhabdomyolysis of this case was caused by severe hypernatremia. On reviewing the literature, only a few cases of rhabdomyolysis due to hypernatremia have been reported.