Deep vein thrombosis complicating severe hypernatremia, rhabdomyolysis, and acute renal failure in a patient with untreated seizure disorder

Abstract

We report a 22-year-old male patient with untreated seizure disorder, presenting with increased frequency of seizures followed by encephalopathy. Laboratory evaluation showed severe hypernatremia (175 meq/l sodium), rhabdomyolysis, and acute renal failure (ARF). Excessive insensible water loss in hot and humid weather, associated with an inability to obtain adequate water replacement, led to a hyperosmolar state (plasma osmolality, 398 mOsm/kg). He was vigorously treated with hypotonic fluid supplement and, further, needed dialysis therapy (peritoneal dialysis followed by hemodialysis) for acute renal insufficiency. The patient survived without any neurological sequelae, but the clinical course was complicated by acute deep vein thrombosis. This case represents what we believe is a unique report in the literature of severe hypernatremia developing via the pathogenic mechanism outlined above and the complication of acute peripheral venous thrombosis, which has not been reported in adults. The purpose of this report is to emphasize hyperosmolarity as a newly described cause of rhabdomyolysis, ARF, and a hypercoagulable state.

Seasonal postpartum hypernatremic encephalopathy with osmotic extrapontine myelinolysis and rhabdomyolysis

“…Rhabdomyolysis is reported in patients with abnormal serum electrolytes including hypokalemia, hyponatremia and hypernatremia. Hypernatremia has been associated with rhabdomyolysis and profound elevation of the serum CK levels with acute renal failure secondary to the rhabdomyolysis [14][15][16][17]. The rhabdomyolysis is hypothesized to occur from osmotic insult and disruption of the muscle membrane, leading to the release of the enzymes and myoglobin.…”

“…Experimental work in rats with induced hypernatremia showed frequent demyelination changes in thalamus, basal ganglia, tegmentum and hippocampus [12] [13]. Rhabdomyolysis with quadriparesis and raised creatine kinase (CK) levels in hypernatremia occurs due to osmotic damage to the muscle membrane [14][15][16][17][18]. Hypernatremia with cerebral imaging abnormalities and rhabdomyolysis has been reported separately.…”

Rare Causes of Rhabdomyolysis; Rhabdomyolysis After Epileptic Seizure and Swimming

“…In our literature survey, rhabdomyolysis due to seizure occurred mostly with repeated seizures and also dehydration of the patient was seen in the reports. Muscle trauma due to falling or muscle injury by muscle forces generated during tonic-clonic seizures may also cause rhabdomyolysis (8)(9)(10)(11)(12)(13).…”

Venous thromboembolism and severe hypernatremia in a patient with lithium-induced nephrogenic diabetes insipidus and acute kidney injury: a case report

“…Hypernatremia can cause central nervous system dysfunction ranging from confusion to coma (7). There are also several case reports of cerebral and systemic circulatory thrombosis associated with hypernatremia (8)(9)(10)(11).…”