Advertisment
Indian Journal of Nephrology About us |  Subscription |  e-Alerts  | Feedback | Login   
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Home | Current Issue | Archives| Ahead of print | Search |Instructions |  Editorial Board  

Users Online:1211

Official publication of the Indian Society of Nephrology
  Search
 
  
 ~  Similar in PUBMED
 ~  Article in PDF (231 KB)
 ~  Citation Manager
 ~  Access Statistics
 ~  Reader Comments
 ~  Email Alert *
 ~  Add to My List *
* Registration required (free)  

 
   References

 Article Access Statistics
    Viewed2006    
    Printed143    
    Emailed0    
    PDF Downloaded166    
    Comments [Add]    
    Cited by others 1    

Recommend this journal

 


 
  Table of Contents  
LETTER TO EDITOR
Year : 2011  |  Volume : 21  |  Issue : 1  |  Page : 66
 

Hypokalemia induced rhabdomyolysis


Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India

Date of Web Publication25-Mar-2011

Correspondence Address:
V V Jain
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha - 442 102, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.78085

Rights and Permissions



How to cite this article:
Jain V V, Gupta O P, Jajoo S U, Khiangate B. Hypokalemia induced rhabdomyolysis. Indian J Nephrol 2011;21:66

How to cite this URL:
Jain V V, Gupta O P, Jajoo S U, Khiangate B. Hypokalemia induced rhabdomyolysis. Indian J Nephrol [serial online] 2011 [cited 2019 Sep 19];21:66. Available from: http://www.indianjnephrol.org/text.asp?2011/21/1/66/78085


Sir,

Rhabdomyolysis is usually associated with hyperkalemia due to renal failure and hence hypokalemia as a cause of rhabdomyolysis is usually missed. [1] We want to highlight the association of hypokalemia with rhabdomyolysis.

An 18-year-old unmarried girl presented with a history of pain in the abdomen and nonbilious vomiting of 4-day duration. This was followed by painful muscle cramps and progressive proximal muscle weakness involving all four limbs. She had no history of diarrhea, diuretic intake, fever, arthralgia, and rash. She had a similar episode of abdominal pain, vomiting, and muscle weakness 2 months prior to this illness which recovered after receiving some IV injections in a private hospital. She had never passed any urine stones. She was normotensive and nondiabetic with a normal thyroid profile. There was no history of drug intake.

On examination she had a blood pressure of 110/70 mm of Hg. The muscle power was 3/5 in proximal muscle groups of all four limbs with flaccidity and depressed deep tendon reflexes. There was no bulbar weakness, no cranial nerves involvement, and no sphincter involvement. Plantar response was flexor. There were no fasciculation, myoclonus, or muscular atrophy.

Investigation showed hypokalemia (1.6 mEq/L), markedly raised creatine phosphokinase (CPK) (7960 IU/L), and metabolic acidosis with high serum lactate. Her serum creatinine was 1.2 mg/dL and serum sodium was 138 mEq/L. The urinanalysis was normal. Urine K + was 5 mEq, suggestive of hypokalemia due to gastrointestinal loss. She was diagnosed as a case of hypokalemia causing rhabdomyolysis. She was treated with fluid replacement and IV potassium replacement. After 10 days, the muscle weakness recovered following a rise in serum potassium. On discharge, her CPK had decreased to 514 IU/L which normalized after 3 weeks.

Our patient had a history of persistent vomiting which led to hypokalemia due to gastrointestinal loss, and urine potassium was low (5 mEq/L). She was normotensive and did not have sodium conservation or features of primary aldosteronism. The renal cause of hypokalemia was also ruled out on the basis of low urinary potassium. Though she had metabolic acidosis, it could have been due to high serum lactate because of rhabdomyolysis itself.

In the literature, there are few documented cases of hypokalemia due to primary aldosteronism [2] leading to rhabdomyolysis. Licorice ingestion, [3] abuse of laxatives, proximal renal tubular acidosis, and diuretics have also been associated with hypokalemia-induced rhabdomyolysis. There are no reports in the literature on hypokalemia due to vomiting leading to rhabdomyolysis.

Potassium plays a major role in regulating the skeletal muscle blood flow; an increased potassium concentration in the muscle during muscle activity causes vasodilatation, which increases the regional blood flow. [4] In state of hypokalemia, this increase is hampered causing relative ischemia in the active muscle consecutively leading to muscle cramps, and in a severely depleted state may cause muscle necrosis and rhabdomyolysis. [4] In addition to hypoperfusion, hypokalemia-induced impairment in muscle metabolism also may contribute to muscle dysfunction. [5]

 
  References Top

1.Agarwal S, Agarwal V, Taneja A. Hypokalemia causing rhabdomyolysis resulting in life threatening hyperkalemia. Pediatr Nephrol 2006;21:289-91.  Back to cited text no. 1
    
2.Goto A, Takahashi Y, Kishimoto M, Minowada S, Aibe H, Hasuo K, et al. Primary aldosteronism associated with severe rhabdomyolysis due to profound hypokalemia. Intern Med 2009;48:219-23.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.van den Bosch AE, van der Klooster JM, Zuidgeest DM, Ouwendijk RJ, Dees A. Severe hypokalaemic paralysis and rhabdomyolysis due to ingestion of liqourice. Neth J Med 2005;63:146-  Back to cited text no. 3
    
4.Knochel JP, Schlein EM. On the mechanism of rhabdomyolysis in potassium depletion. J Clin Invest 1972;51:1750.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Knochel JP. Neuromuscular manifestations of electrolyte disorders. Am J Med 1982;72:521.  Back to cited text no. 5
[PUBMED]    



This article has been cited by
1 Primary Aldosteronism with Rhabdomyolysis: A Case Report
Lei Zhang,Hong-Jian Shi
Journal of Musculoskeletal Pain. 2014; 22(1): 102
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
 

    

Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07