Downer cow syndrome causing rhabdomyolysis and acute renal failure in a 17-month-old Guzerá heifer / Síndrome da vaca caída causando rabdomiólise e insuficiência renal aguda em uma novilha Guzerá de 17 meses

The downer cow syndrome (DCS) is characterized by an alert cow showing inability or reluctance to stand for 12 hours or more. This paper reported clinical, laboratory, and pathological findings in a Guzerá heifer with rhabdomyolysis, pigmenturia and acute renal failure following DCS. A 17-month-old Guzerá heifer was transported via a 350-km ride in a truck and showed sternal recumbency and severe difficulty in standing and walking. Neurological examination was unremarkable, and the heifer presented normal response to cranial nerves and spinal cord tests. Rectal palpation revealed a 5-month gravid uterus. No other abnormalities were noted in the pelvis or around the coxofemoral joints. Biochemical abnormalities included extremely high muscular enzyme activities (creatine phosphokinase and aspartate aminotransferase) and high creatinine levels. Urinalysis revealed blackish and cloudy urine, proteinuria, and a positive occult blood test. Spinal cord ultrasonography showed no abnormalities. This report highlighted an uncommon clinical presentation (myoglobinuria) and pathological findings in a heifer with DCS as a consequence of severe compressive muscle damage. Practitioners and producers must be aware of the risk of careless road transportation for long distances of cattle, especially obese cows, avoiding unnecessary suffering and expenses due to DCS.

A síndrome da vaca caída (SVC) é caracterizada por um bovino alerta que mostra incapacidade ou relutância em permanecer em estação por 12 horas ou mais. O objetivo deste trabalho é relatar os achados clínicos, laboratoriais e patológicos em uma novilha Guzerá com rabdomiólise, pigmentúria e insuficiência renal aguda após a SVC. Uma novilha da raça Guzerá, de 17 meses de idade, foi transportada de caminhão por 350 km e apresentou decúbito esternal, grande dificuldade para assumir estação e caminhar. O exame neurológico não demonstrou alterações, e a novilha possuía resposta normal aos testes de nervos cranianos e medula espinhal. A palpação retal revelou útero grávido de cinco meses. Nenhuma outra anormalidade foi observada na pelve ou na região das articulações coxofemorais. As anormalidades bioquímicas incluíram atividades de enzimas musculares (creatina fosfoquinase e aspartato aminotransferase) extremamente aumentadas e níveis elevados de creatinina. A urinálise revelou urina enegrecida e turva, proteinúria e teste de sangue oculto positivo. O exame ultrassonográfico da medula espinhal não apresentou anormalidades. Este relato evidencia uma apresentação clínica (mioglobinúria) e achados patológicos incomuns em uma novilha com SVC em consequência de extensa lesão muscular compressiva. Veterinários e produtores devem estar atentos aos riscos do transporte rodoviário descuidado por longas distâncias de bovinos, especialmente vacas obesas, evitando assim sofrimento e despesas desnecessárias decorrentes da SVC.

The curative effects of methylsulfonylmethane against glycerol-induced acute renal failure in rats

Abstract The present study was performed to explore the curative effect of Methylsulfonylmethane (MSM) in an experimental model of myoglobinuric acute renal failure (ARF). In this experimental model, Rats were injected with 50% glycerol (10 mL/kg, im) followed by an hour later and daily in the next six days by MSM (400 mg/kg) or saline. Kidney's function (urea and creatinine), and reduced glutathione were analyzed. A renal failure produced by glycerol injection, with a significant increase of blood urea and serum creatinine was observed. Rats that received MSM in addition to glycerol had significantly lower blood urea and serum creatinine levels compared to those receiving glycerol alone. However, glutathione has markedly increased after MSM treatment. The effect is probably due to the antioxidant activity of MSM. This may provide therapeutic opportunities for treating humans, myoglobinuric ARF.

Hemoglobinuria paroxística nocturna / Paroxysmal nocturnal hemoglobinuria

ResumenLa hemoglobinuria paroxística nocturna es una anemia hemolítica crónica, adquirida, poco común, que afecta con igual frecuencia ambos sexos. Se manifiesta a cualquier edad y con mayor incidencia en países del sudeste asiático. Es el resultado de la expansión clonal no maligna de células progenitoras hematopoyéticas. Se caracteriza por anemia hemolítica intravascular, tendencia a la trombosis y un componente variable de insuficiencia medular.Se asocia a otras patologías hematológicas como anemia aplásica y síndrome mielodisplásico. La citometría de flujo es el método de elección para diagnóstico. El eculizumab y el trasplante de médula ósea alogénico son las únicas terapias efectivas.

Abstract:Paroxysmal nocturnal hemoglobinuria is a rare acquired chronic hemolytic anemia, which affects both sexes with equal frequency. It occurs at any age and more frequently in Southeast Asian countries. It is the result of non malignant clonal expansion of hematopoietic progenitor cells. It is characterized by intravascular hemolytic anemia, recurrent thrombosis and a variable component of bone marrow failure. It is associated with other hematologic disorders such as aplastic anemia and myelodysplastic syndrome. Flow cytometry is the method of choice for diagnosis. Eculizumab and allogeneic bone marrow transplantation is the only effective therapies.

Severe Fever with Thrombocytopenia Syndrome Presenting with Rhabdomyolysis

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging febrile illness. While many kinds of severe complications including acute renal failure have been reported, rhabdomyolysis is rarely reported in association with SFTS. A 54-year-old female farmer was admitted with fever and diffuse myalgia. Laboratory finding showed thrombocytopenia, leukopenia, azotemia, extremely elevated muscle enzyme levels and myoglobinuria. We describe a fatal case of rhabdomyolysis with acute renal failure complicated by SFTS.

Rhabdomyolysis after prolonged laparoscopic radical nephrectomy: A case report

Rhabdomyolysis is characterized by the breakdown of skeletal muscle and the subsequent release of intracellular contents into the circulatory system. It is potentially life-threatening because it is sometimes associated with very high creatine kinase levels, myoglobinuria, and acute renal failure. We experienced a case of postoperative rhabdomyolysis after prolonged laparoscopic radical nephrectomy in the semi-lateral decubitus position. It was associated with suspicious gluteal compartment syndrome. Fortunately, the patient's renal function was normal through his hospital course. Rhabdomyolysis is well worth considering at the point of intraoperative positioning and postoperative care after prolonged surgery.

Coexistence of VHL Disease and CPT2 Deficiency: A Case Report / Journal of the Korean Cancer Association, 대한암학회지

von Hippel-Lindau (VHL) disease is an inherited syndrome manifesting with benign and malignant tumors. Deficiency of carnitine palmitoyltransferase type II (CPT2) is a disorder of lipid metabolism that, in the muscle form, manifests with recurrent attacks of myalgias often associated with myoglobinuria. Rhabdomyolytic episodes may be complicated by life-threatening events, including acute renal failure (ARF). We report on a male patient who was tested, at 10 years of age, for VHL disease because of family history of VHL. He was diagnosed with VHL but without VHL-related manifestation at the time of diagnosis. During childhood, the patient was hospitalized several times for diffuse muscular pain, muscle weakness, and dark urine. These recurrent attacks of rhabdomyolysis were never accompanied by ARF. The patient was found to be homozygous for the mutation p.S113L of the CPT2 gene. To the best of our knowledge, this is the first report of the coexistence of VHL disease and CPT2 deficiency in the same individual. Based on findings from animal models, the case illustrates that mutations in the VHL gene might protect against renal damage caused by CPT2 gene mutations.

Rabdomiólisis en la primera semana de entrenamiento. reporte de dos casos / Rhabdomyolysis at the first week of training. two cases report / Rabdomiólise na primeira semana de treinamento. relato de dois casos

La rabdomiólisis es un síndrome causado por lesión al músculo estriado con liberación de contenido celular muscular a la circulación, puede causar acidosis láctica, hiperfosfatemia, coagulación intravascular diseminada, hiperkalemia, síndrome compartimental, falla renal, e incluso puede comprometer la vida del paciente. La triada de síntomas incluye mialgias, debilidad y como manifestación cardinal orina de color rojoachocolatado, frente a lo cual se debe establecer diagnóstico diferencial ante la aparente eritrocituria e interrogarse sobre el uso de fármacos que enrojezcan la orina. El desconocimiento clínico y la demora diagnóstica, retardan el tratamiento específico incrementando así la morbimortalidad. El diagnóstico se puede confirmar ágilmente demostrando niveles elevados de: creatinina fosfoquinasa (CPK) sérica, análisis metabólicos, mioglobinuria, análisis de las enzimas intracelulares transaminasa glutámicooxalacético/ aspartato aminotransferasa (GOT/ASAT), transaminasa glutámico pirúvico/alanino aminotransferasa (GPT/ALAT). El tratamiento está encauzado a acelerar la recuperación, identificar y corregir cualquier causa reversible de lesión muscular al igual que prevenir y tratar las complicaciones, la infusión oportuna y agresiva de cristaloides es el pilar del tratamiento, el uso de manitol, bicarbonato y antioxidantes aún es controvertido. En este reporte de casos se muestran las manifestaciones clínicas típicas de rabdomiólisis en dos hombres durante la primera semana de entrenamiento, en quienes se precipitó esta condición por deshidratación, actividad física intensa, inadecuada vestimenta y exposición a temperatura ambiental elevada (mayor a 25°C). Estos pacientes fueron rápidamente diagnosticados, y recibieron tratamiento oportuno por lo que no presentaron complicaciones, actualmente están asintomáticos.

Rhabdomyolysis is a syndrome caused by breakdown of skeletal muscle with release of muscle cell contents into the bloodstream, may cause lactic acidosis, hyperphosphatemia, disseminated intravascular coagulation, hyperkalemia, compartment syndrome, renal failure, and may even jeopardize the patient's life. The triad of symptoms including myalgia, weakness and urine - chocolate - red color as a cardinal manifestation, against which must be set before the differential diagnosis erythrocyturia apparent and question the use of drugs that turn red urine. Clinical ignorance and delay in diagnosis slow down specific treatment. The diagnosis can be confirmed swiftly demonstrating elevated levels of serum creatine phosphokinase (CPK), metabolic analysis, myoglobinuria, analysis of intracellular glutamic oxaloacetic transaminase/aspartate aminotransferase enzymes (ALT/AST), glutamic pyruvic transaminase/alanine aminotransferase (GPT/ALAT). Treatment is aimed at accelerating recovery, identifying any reversible cause of muscle injury, prevent and treat complications, timely and aggressive crystalloid infusion is the mainstay of treatment, the use of mannitol, bicarbonate and antioxidants even is controversial. This case report shows the typical clinical manifestations of rhabdomyolysis in two men in the first week of training, in whom this condition was precipitated by dehydration, intense physical activity, inadequate clothing and exposure to high ambient temperature (above 25°C). These patients were quickly diagnosed and received timely treatment so no present any complications, actually they are asymptomatic.

A rabdomiólise é uma síndrome causada por lesão do músculo estriado com libertação do conteúdo das células musculares para a torrente sanguínea, a suas causas são acidose láctica, hiperfosfatemia, coagulação intravascular disseminada, hipercalemia, síndrome do compartimento, insuficiência renal, e pode mesmo comprometer a vida do paciente. A tríade de sintomas inclui mialgias, fraqueza e, como manifestação cardinal, urina de cor vermelho - achocolatado, por isso é preciso estabelecer um diagnostico diferencial ante a eritrocitária aparente e questionar sobre os medicamentos que tornam a urina vermelha. A ignorância clínica e atraso de diagnóstico retardam o tratamento específico aumentando assim a morbidade e mortalidade. O diagnóstico pode ser confirmado rapidamente demonstrando níveis elevados de: creatinina fosfoquinase (CPK), análises metabólicos, mioglobinúria, análises das enzimas intracelulares transaminase glutâmico-oxalacética/aspartato aminotransferase (TGO/AST), transaminase glutâmico pirúvica/alanina aminotransferase (TGP/ALT). O tratamento tem sido orientado para acelerar a recuperação, identificar e corrigir qualquer causa reversível de lesão muscular assim como prevenir e tratar complicações. A infusão oportuna e agressiva de cristaloides é a base do tratamento, a utilização de manitol, bicarbonato e antioxidantes é ainda controversa. Neste informe de casos se revelam as manifestações clinicas tipicas de rabdomiólise em dois homens durante a primeira semana treinamento, em eles foi manifestada esta condição por desidratação, atividade física intensa, roupas inadequadas e exposição ao ambiente de alta temperatura (superior a 25). Estes pacientes foram rapidamente diagnosticados e eles receberam um tratamento oportuno pelo qual eles não presentaram complicações e atualmente eles não têm nenhum sintoma.

Compartment Syndrome Following Total Knee Arthroplasty: Clinical Results of Late Fasciotomy

Compartment syndrome after total knee arthroplasty (TKA) is a rare complication. Because of its rarity, it may be overlooked and misdiagnosed as peroneal nerve palsy or deep vein thrombosis. This misdiagnosis could have a profound impact on the patient's outcome. We report a case of a 77-year-old female who developed unilateral compartment syndrome in the calf after staged bilateral TKA at an outside clinic. The patient presented with medical complications related to compartment syndrome: rhabdomyolysis and myoglobinuria, which caused acute renal failure. Thus, we performed late fasciotomy one week after symptom onset to debride necrotic tissue and salvage the compartment. In the discussion section, we will discuss risk factors for compartment syndrome after TKA, results of late fasciotomy and other indications for surgical treatment of compartment syndrome.

Análisis bioquímico de mioglobinuria asociada con rabdomiolisis / Biochemical analysis of myoglobinuria associated with rhabdomyolysis / Análise bioquímica de mioglobinúria associada com rabdomiólise

La destruccion del músculo esquelético en la condición patológica conocida como rabdomiolisis resulta en la liberación al torrente sanguíneo de elevadas concentraciones de la proteína mioglobina de 17 kDa, la cual filtra libremente a través del glomérulo sobrepasando frecuentemente la capacidad de reabsorción del túbulo proximal. Por lo tanto, la identificación de mioglobina en orina es una herramienta esencial que complementa otros parámetros bioquímicos en el diagnóstico de la enfermedad. En el presente trabajo, mediante la combinación de electroforesis en geles de agarosa e inmunofijación empleando anticuerpos específicos, se provee evidencia directa de la presencia de mioglobina intacta en la orina de un paciente con insuficiencia renal aguda asociada a rabdomiolisis desencadenada por efecto secundario de una terapia reductora de lípidos. Los datos electroforéticos e inmunoquímicos fueron corroborados mediante secuencia N-terminal de aminoácidos, immunoblot y espectrometría de masa. La simple combinación de electroforesis e inmunofijación provee una estrategia flexible que puede extenderse a la identificación de diversas proteínas involucradas en proteinurias de sobrecarga.

Trauma de extremidades: avaliação e manejo inicial das lesões graves e ameaçadoras da vida / Trauma of limbs: evaluation and initial management of severe, life-threatening injuries

Este artigo versará sobre as lesões musculoesqueléticas graves que podem trazer risco à vida, na importância do seu reconhecimento precoce e manejo inicial dessas lesões, que deverão ser realizadas pelo médico no departamento de emergência.

This article discusses the severe musculoskeletal injuries that can bring serious risk to life, the initial evaluation and management of these injuries that must be performed by the physician in the emergency department.

A Case of Chronic Renal Failure Associated with Systemic Capillary Leak Syndrome / 영남의대학술지

Systemic capillary leak syndrome (SCLS) is an unusual entity characterized by hypovolemic shock, hemoconcentration, and hypo-albuminemia associated with paraproteinemia as a result of marked capillary hyperpermeability. Complications of this syndrome can include compartment syndromes, pulmonary edema, thrombosis, and acute kidney injury. This paper reports a case of severe SCLS accompanied by acute tubular necrosis caused by hypoperfusion and myoglobinuria secondary to rhabdomyolysis, which resulted in chronic kidney disease that necessitated hemodialysis. However, there have been rare data of residual end-organ damage after acute attacks in Korea. Therefore, this paper reports a case of complicated SCLS enough to hemodialysis and that developed into chronic kidney disease.

Rabdomiolisis inducida por ejercicio en adolescentes chilenos / Exercise-induced rhabdomyolysis in Chilean adolescents

Rabdomiolisis es la destrucción de las fibras musculares y se caracteriza clínicamente por dolor, edema y debilidad muscular, orina color rojo-café (mioglobinuria) y la elevación por un corto período de la enzima creatinquinasa en sangre. Entre las múltiples causas de rabdomiolisis está el ejercicio intenso. La rabdomiolisis inducida por el ejercicio está escasamente documentada en la población pediátrica y en general requiere descartar alguna patología metabólica de base. Las complicaciones de la rabdomiolisis pueden ser múltiples y graves: falla renal, arritmias cardíacas, síndrome compartamental, coagulación intravascular diseminada, acidosis láctica, etc. La falla renal es consecuencia de la necrosis tubular aguda secundaria al taponamiento de los túbulos renales por la mioglobina, que puede llegar a ser fatal. Comunicamos nuestra experiencia con tres adolescentes que después de iniciar un programa de entrenamiento físico, desarrollaron intenso dolor y edema muscular constatándose un significativo aumento de la enzima creatinquinasa y edema muscular en la ultrasonografía de los músculos utilizados en el ejercicio. El estudio complementario descartó una patología metabólica de base en todos ellos. El tratamiento oportuno incluyó terapia sintomática e hidratación intravenosa. No se desarrolló insuficiencia renal en ninguno. Frente al incremento no controlado del entrenamiento físico, el diagnóstico oportuno de esta patología permite evitar sus graves consecuencias.

Rhabdomyolysis implies injury to the muscle fibers. The hallmark clinical manifestations are pain, oedema, muscle weakness and dark urine (myoglobinuria). There is an increase, for a short time, of the muscle enzyme creatine kinase in blood. Exercise induced rhabdomyolysis is one of various causes of rhabdomyolysis but has been rarely documented in the pediatric population. In general it is always important to exclude an underlying metabolic pathology. Complications of rhabdomyolysis can be many and severe: renal failure, cardiac arrhythmias, compartment syndrome, disseminated intravascular coagulation, lactic acidosis, etc.. Renal failure is the consequence of the acute tubular necrosis secondary to the obstruction of the renal tubules by myoglobin, which can become fatal. We report our experience with three adolescents that after starting a program of physical training, developed intense pain and muscle oedema at the ultrasound scan of the muscles involved in the exercise. Complementary studies excluded an underlying metabolic disease in all of them. The opportune treatment included symptomatic treatment and endovenous hydratation. Fortunately, none of them developed renal failure.

Statin-Induced myopathy: a clinical perspective

Statins are at the forefront of treatments for hyperlipidemia, coronary artery disease and stroke. Patients may not adhere to Statins therapy due to hepatic or neuromuscular side effects that include neuropathy and myopathy. The latter include myalgia, lassitude, fatigue, proximal muscle weakness with or without elevated creatine kinase [CK] or myoglobinuria. Studies suggest that these symptoms are under reported and may occur in as much as 5% or more. This article reviews the definition, incidence, possible mechanisms, risk factors, clinical presentation and suggested management of Statin-induced myopathy

Gluteal and Thigh Compartment Syndrome due to Rhabdomyolysis Following Prolonged Immobilization: A Case Report / 대한신장학회지

Compartment syndrome is rarely associated with non-traumatic rhabdomyolysis. We report the case of a 23-year-old man who developed compartment syndrome associated with rhabdomyolysis caused by prolonged immobilization after antidepressive drug overdose. Elevation of serum creatine phosphokinase and myoglobinuria indicated rhabdomyolysis. Painful swelling of the right buttock and thigh and right lower limb paralysis with sensory and motor deficit were suggestive of gluteal and thigh compartment syndrome with the complication of sciatic nerve injury. The patient received an immediate fasciotomy, medical treatment and rehabilitation. At five months after initial treatment, the patient could walk independently with nearly full recovery of his right lower limb function.

Successful Treatment of Hypercalcemia During Continuous Renal Replacement Therapy in Patient with Rhabdomyolysis Following Cardioversion and Cardiopulmonary Resuscitation / 대한신장학회지

Rhabdomyolysis is a common clinical and laboratory syndrome resulting from reversible skeletal muscle injury, with release of muscle cell contents into the plasma. Cardioversion, and cardiopulmonary resuscitation may produce rhabdomyolysis and myoglobinuria. We report a 5-year-old boy surviving after cardiopulmonary resuscitation and repeated 5 times of cardioversion. He showed elevated serum BUN and creatinine levels, requiring hemodialysis treatment. We had tried 5 times of intermittent hemodialysis, but oliguria was continued and there was no change of serum BUN and creatinine. His urine output was less than 100 cc per day and he showed severe edema and weight gain of 7 kg, and so we started the continuous renal replacement therapy (Prismaflex(R), gambro). After 12 days of continuous venovenous hemodiafiltration (CVVHDF), his urine output recovered and his BUN, creatinine, liver enzyme, creatine kinase, and lactate dehydrogenase levels returned to normal. During the treatment of CVVHDF, he had shown persistent hypercalcemia, and so we changed dialysate and replacement solution from hemosol B0 to calcium free solution. The hypercalcemia was controlled successfully using this calcium free pharmacy-made bicarbonate solution.

Treatment for crush syndrome of extremities with antioxidants / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical therapeutic effect of antioxidants assistant treatment of extremities crush syndrome (CS)in order to find new therapy.</p><p><b>METHODS</b>Twenty-one male patients (aged from 24 to 48 years, mean 36 years) were treated with the next antioxidants in early stage: (1) 20% Mannitol 250 ml intravenous drip in 30 minutes (one time per 6 to 8 h). (2) Sodium aescinate 20 mg, Salvia Miltiorrhiza 20 ml were dissolved respectively in isotonic saline or 5% glucose 200 ml and dripped by intravenous drip (50 to 60 drips per minute). The drugs were used for 5 to 7 days (one time per day). Basifying urine, keeping the nagative liquid banlance and electrolyte banlance, preventing infection and hold out treatment were done. When the pressure of muscular osteofascial compartment was more than 30 mmHg, deep fasia was cut to decompress timely and the above-mentioned drugs were continuously applied for patients.</p><p><b>RESULTS</b>Myoglobin urine of 21 cases died out after 2 to 3 days, of them, 13 cases were performed to decompress. After open decompression, 2 cases suffered from amputation because of long time of ischemia, 2 cases took place slight dysfunction of lower limbs, one hand had ischemia muscular contracture in 1 case and one foot down-vertical in 1 case. After followed-up of 8 months to 1 year, according to the function standard, the result were excellent in 8 cases, good in 7 cases, fair in 2 cases, poor in 4 cases. The excellent and good rate was about 71.4% (15/21).</p><p><b>CONCLUSION</b>After extremities crushed for long time, application of antioxidents as early as possible can decrease significantly the incidence and invalidity rate of CS.</p>

Elevation of Serum Creatine Kinase Level in a Patient Treated with Atypical Antipsychotics: A Case Report / 대한정신약물학회지

We report a case of serum creatine kinase (CK) elevation in a 42-year-old man with schizoaffective disorder treated with olanzapine, aripiprazole, quetiapine, and modified electroconvulsive therapy (ECT). To elucidate the clinical meaning of serum CK elevation, we repeatedly measured psychotic severity and chemical data, including serum CK, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and cholesterol. Pearson's correlation analysis was performed between each measurement. The peak CK level during hospitalization was correlated with Clinical Global Impression (CGI) severity. Dissociation of CK level and myoglobinuria was observed, and elevated did not result in renal failure or any renal decompensation. Medication change among atypical antipsychotics could not terminate CK level, which did not seem to be associated with dosage or duration of use. The patient's mother showed similar CK level, which suggests genetic control of serum CK. Repeated measurement of serum CK is recommended for determining the clinical significance of CK level, which is not yet clear.

Rabdomiólisis: patogenesia, aspectos y tratamiento clínicos / Rhabdomyolisis: pathogenesis, clinical features and treatment

La raabdomiólisis es un sindrome causado por la lesión en el músculo esquelético y la resultante liberación del contenido de las células musculares (mioglobina, potasio, fosfato, etc.) dentro del plasma. 5...El diagnóstico de rabdomiólisis queda establecido por una marcada elevación de la CPK sérica mayor a 10.000UI/L. El tratamiento tiene como objetivo prevenir la insuficiencia renal aguda, la cual es la complicación más grave de este sindrome.

A Case of Hyponatremia Complicated by Rhabdomyolysis during Clozapine and Nemonapride Treatment / 대한정신약물학회지

We experienced a case of severe hyponatremia complicated by rhabdomyolysis in a schizophrenic patient who had been treated with clozapine and nemonapride. The exact cause of sudden hyponatremia was uncertain, however, the possibility of chronic polydipsia could not be ruled out. Electrolyte imbalance was corrected by isotonic saline infusion, and plasma sodium concentration returned to normal after 24 hours. However, the patient developed severe rhabdomyolysis with myoglobinuria and acute renal failure. After 18 days of treatment, patient's physical and mental condition stabilized without further complication. Possible contribution of clozapine in increasing the risk of rhabdomyolysis after the correction of hyponatremia was briefly discussed.

A Case of Rhabdomyolysis with Community Acquired Pneumonia / 결핵및호흡기질환

A-67-year old man was hospitalized due to fever, cough and dyspnea upon exertion, and was treated with intravenous antibiotics. During the hospital course he presented with weakness in his low extremities. The laboratory tests showed an elevated CK level and myoglobinuria. He was diagnosed with rhabdomyolysis with community-acquired pneumonia and treated accordingly. Subsequently, his symptoms and signs of rhabdomyolysis improved.