ABSTRACT
Objective: To analyze the reasons of rhabdomyolysis (RM) misdiagnosed with diabetetic ketoacidosis (DKA), to clarify the mechanisms of metabolic acidosis caused by RM and DKA, and to enhance the clinical understanding of RM and metabolic acidosis. Methods: The general situation, clinical manifestation, laboratory examination results of the patient who was admitted with DKA and was diagnosed as RM in our department, were collected. Based on the literatures, the causes and manifestations of RM, as well as the treatments and prognosis of the acute kidney injure (AKD induced by RM, and the reasons of RM of the presented patient were analyzed; the similiarities and differences of the mechanisms and treatments of metabolic acidosis caused by AKI induced by RM and DKA were discussed. Results: The patient who was a 56 year-old female with hyperlycemia for 15 years, and fatigue, nausea and vomiting for 4 d was admitted. The physical examination results showed facial edema, dry tongue, poor skin elasticity, heart rate 110 min-1, severe depressed edema of extremities, muscle strength IT level. The anxiliary examination results demonstrated that the levels of blood muscle enzymes, myoglobin, urea nitrogen and creatinine were increased; the blood gas analysis indicated metabolic acidosis, accompanying with electrolyte disturbance and abnormal blood routine. According to the history, symptoms and signs, as well as the laboratory test results, the patient was diagnosed as RM, AKI, metabolic acidosis combined with respriatory alkalosis, electrolyte disturbance, and so on. The clinical symptoms and signs of the patient were recovered, and the blood creatine kinase, myoglobin and renal fuction were significantly improved after the treatment of adequate volume replacement, alkalization and protection of vital organs; the patient had a good prognosis. Conclusion: The diabetic patients may suffer from metabolic acidosis due to various causes which should be paid attention to differential diagnosis. There are some differences of the mechanisms and treatments of metabolic acidosis caused by AKI and DKA. If given the treatment of adequate volume replacement, alkalization early and aggressively, the metabolic acidosis caused by RM combined with AKI can have an excellent prognosis.
ABSTRACT
It is important to test creatine kinase in patients with acute diabetic complications in order to detect rhabdomyolysis,especially subclinical rhabdomyolysis.The prognosis of rhabdomyolysis can be improved when it is treated once diagnosed.However,endocrinologists sometimes neglect the diagnosis of rhabdomyolysis.Here,we reviewed the pathogenesis of rhabdomyolysis caused by acute diabetic complications,and also the clinical features,diagnosis,treatment and prognosis of rhabdomyolysis.