Acute Renal Failure in Rhabdomyolysis Associated with Furosemide Induced Hypokalemia / 대한신장학회잡지

ABSTRACT

Though hypokalemia often goes unrecognized as a cause of rhabdomyolysis, its causal relation for acute renal failure can be considered in cases of extreme hypokalemia when combined with rhabdomyolysis. We present the case of a 21-year-old female in whom acute renal failure was developed by myoglobinuria which was associated with furosemide induced hypokalemia. She had taken 2 grams of furosemide daily over 6 months before developing rhabdomyolysis. Initial neurologic examination revealed painful quadriplegia and laboratory findings showed markedly elevated blood CPK, LDH and AST levels with azotemia. Arterial blood gas analysis showed pH 7.439, serum Na 128mEq/L, K 1.5mEq/L, Cl 87mEq/L, HCO3- 12.6mmol/L and calculated anion gap of 29.9 which indicated that she was under the condition of mixed metabolic alkalosis and metabolic acidosis. Though intravenous infusion of potassium chloride improved muscle strength, azotemia and acidemia persisted for several days. This case suggest that large amount of furosemide, when used for a long time, can be result in the acute renal failure by rhabdomyolysis which was caused by hypokalemia.