Poster 366 Hypokalemia‐Induced Rhabdomyolysis in a 61‐year‐old Woman: A Case Report

Abstract

Conclusion:Consistent clinical features of iliac stress fractures appear to be pain over the iliac bone that may also be noted over the lateral hip or gluteal region, tenderness along the affected area, and elicitation of pain with flexion of the affected hip. MRI of the pelvis will demonstrate the stress fracture whereas plain radiography is typically negative. A period of relative rest for approximately one month followed by a gradual return to play management strategy has allowed previously affected patients to resume their activity successfully. A 61-year-old woman presented to the emergency room with first time onset of bilateral lower extremity weakness. Her only medical history was hypertension, asthma, and recently evaluated chronic back pain. Her medications were lisinopril and HCTZ, the latter of which she had not taken in two months. Physical examination was significant for proximal muscle strength of 2/5 in the shoulders and hip flexors, and 3/5 in all other distal muscle groups, with otherwise normal neurologic exam. Early labwork showed a potassium of 1.8, whereby she was given 50mEq of IV potassium, 320mEq of oral potassium, and lisinopril 40mg. Despite repeat potassium repletions, the patient continued to have K values of 1.8, 2.1, 2.2, and the patient further reported drinking and voiding frequently and severe pain in her legs, which was not responsive to gabapentin or opioids. She began to complain of pain in her legs, and was found to have a CK of 15,212, upon which a high rate of maintenance fluids was started. CK value climbed to 61,546, and urine was positive for myoglobin (332). CBC was unremarkable, CRP was not elevated at 0.5, and other routine tests for causes of muscle injury, ANA, SSA antibody, RF, TSH, Utox were all negative. Setting: Inpatient hospital. Results or Clinical Course: With appropriate fluid replacement and potassium repletion continued over a week, the patient's potassium and CK values normalized and weakness and pain improved. Discussion: The patient had no history of trauma, cocaine, burn, or prolonged immobility, which are typical risk factors for rhabdomyolysis. Furthermore, her case was associated with hypokalemia rather than hyperkalemia. An accepted, but unusual cause of rhabdomyolysis is severe hypokalemia.The mechanism of this disease occurs by the effect of extracellular potassium on blood vessels-which causes vasodilatation during muscle activity. This vasodilation normally increases the regional blood flow. Hypokalemia, however, causes relative ischemia in the active muscle leading to muscle cramps, and if severe, muscle necrosis and rhabdomyolysis. Conclusion: Severe hypokalemia is an important cause of muscle weakness and rhabdomyolysis that must be corrected aggressively.

Secondary hypokalemic myoplegias

“…У 2 больных с ВГМ, возникшими на фоне нетравматического рабдомиолиза, наблюдались различные варианты развития ГП: медленное нарастание мышечной слабости с внезапным усилением парезов и рецидивирующие пароксизмальные нервно-мышечные нарушения. В обоих случаях отмечалось более продолжительное восстановление мышечной силы по сравнению с регрессом гипокалиемии, хотя некоторые авторы описывают одинаковый регресс мышечной слабости и гипокалиемии [30]. При рецидивирующем рабдомиолизе целесообразно проводить диагностический поиск почечного тубулярного ацидоза или синдрома Фанкони [31].…”