Rhabdomyolysis After Hyperemesis Gravidarum

Lassey, Sarah C.; Robinson, Julian N.

doi:10.1097/aog.0000000000001418

Cited by 29 publications

(15 citation statements)

References 6 publications

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“…Potassium abnormalities have been noted to increase the mortality associated with hyperemesis. Case reports have identified profound hypokalemia leading to rhabdomyolysis in the setting of hyperemesis gravidarum [24]. …”

Section: Maternal Complicationsmentioning

confidence: 99%

Hyperemesis Gravidarum: A Review of Recent Literature

et al. 2017

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Background: In the United States, hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for hospitalizations in pregnancy overall. In approximately 0.3-3% of pregnancies, hyperemesis gravidarum is prevalent and this percentage varies on account of different diagnostic criteria and ethnic variation in study populations. Despite extensive research in this field, the mechanism of the disease is largely unknown. Although cases of mortality are rare, hyperemesis gravidarum has been associated with both maternal and fetal morbidity. The current mainstay of treatment relies heavily on supportive measures until improvement of symptoms as part of the natural course of hyperemesis gravidarum, which occurs with progression of gestational age. However, studies have reported that severe, refractory disease manifestations have led to serious adverse outcomes and to termination of pregnancies. Summary: Despite extensive research in the field, the pathogenesis of hyperemesis gravidarum remains unknown. Recent literature points to a genetic predisposition in addition to previously studied factors such as infectious, psychiatric, and hormonal contributions. Maternal morbidity is common and includes psychological effects, financial burden, clinical complications from nutritional deficiencies, gastrointestinal trauma, and in rare cases, neurological damage. The effect of hyperemesis gravidarum on neonatal health is still debated in literature with conflicting results regarding outcomes of birth weight and prematurity. Available therapy options remain largely unchanged in the past several decades and focus on parenteral antiemetic medications, electrolyte repletion, and nutritional support. Most studies of therapeutic options do not consist of randomized control studies and cross-study analysis is difficult due to considerable variation of diagnostic criteria. Key Messages: Hyperemesis gravidarum carries a significant burden on maternal health and US health care. Most published research on pathogenesis is observational and suggests multifactorial associations with hyperemesis gravidarum. Precise, strictly defined criteria for clinical diagnosis are likely to benefit meta-analyses of further research studies regarding pathogenesis as well as therapeutic options.

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Section: Maternal Complicationsmentioning

confidence: 99%

Hyperemesis Gravidarum: A Review of Recent Literature

et al. 2017

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“…Indeed, hypokalemia is associated with emergency operative delivery (adjusted odds ratio: 2.7) [10]. It would be rare, but HG is also related to osmotic demyelinating syndrome due to hyponatremia [13], Wernicke's encephalopathy due to vitamin B1 (thiamine) deficiency [14] and hypokalemic myopathy [7,8]. Although intravenous treatment strategy is not established, it is reported that intravenous rehydration with 5% dextrose-0.9% saline or 0.9% saline solution in women hospitalized for HG produced similar outcomes [15].…”

Section: Hyperemesis Gravidarum (Hg)mentioning

confidence: 99%

“…Although the pathophysiological causal relationship is understandable, only two cases with simultaneous onset of rhabdomyolysis and diabetes insipidus (DI) due to HG associated hypokalemia have been reported [7,8]. We herein describe a rare and instructive case of HG followed by RFS associated hypokalemia induced rhabdomyolysis and nephrogenic DI, successfully treated with oral supplementation of potassium chloride tablets.…”

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confidence: 97%

Hyperemesis gravidarum followed by refeeding syndrome causes electrolyte abnormalities induced rhabdomyolysis and diabetes insipidus

et al. 2019

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Although hyperemesis gravidarum (HG), an extreme form of morning sickness, is a common complication during pregnancy, HG associated simultaneous onset of rhabdomyolysis and diabetes insipidus due to electrolyte abnormalities are rare. A 34-year-old woman with severe HG at 17 weeks of gestation complicated with appetite loss, weight reduction by 17 kg, general fatigue, myalgia, weakness and polyuria was identified to have simultaneous hypophosphatemia (1.6 mg/dL) and hypokalemia (2.0 mEq/L). Appetite recovery and the improvement of the hypophosphatemia (3.2 mg/dL) were observed prior to the first visit to our department. At the admission, she presented polyuria around 7,000~8,000 mL/day with impaired concentrating activity (U-Osm 185 mOsm/L), and abnormal creatine kinase elevation (4,505 U/L). The electrolyte disturbances and physio-metabolic abnormalities in undernourished state due to HG let us diagnose this case as refeeding syndrome (RFS). In this case, abnormal loss by vomiting, insufficient intake and previous inappropriate fluid infusion as well as the development of RFS may accelerate the severity of hypokalemia due to HG. Thus, as her abnormalities were considered as results of rhabdomyolysis and diabetes insipidus due to severe HG associated hypokalemia based on RFS, oral supplementation of potassium chloride was initiated. After 6 days of potassium supplementation, her symptoms and biochemical abnormalities were completely resolved. Severe HG followed by RFS can be causes of electrolyte abnormalities and subsequent complications, including rhabdomyolysis and renal diabetes insipidus. Appropriate diagnosis and prompt interventions including adequate nutrition are necessary to prevent electrolyte imbalance induced cardiac, neuromuscular and/or renal complications.

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“…The most common cause of hypokalaemia in pregnancy is hyperemesis gravidarum . Gitelman syndrome is the second most commonly reported cause of hypokalaemia .…”

Section: Laboratory Investigationsmentioning

confidence: 99%

“…33,34 The most common cause of hypokalaemia in pregnancy is hyperemesis gravidarum. 50 Gitelman syndrome is the second most commonly reported cause of hypokalaemia. 51 Unusual causes of hypokalaemia in pregnancy include pica/geophagia, excessive ingestion of caffeine or carbonated beverages, hyperventilation, renal tubular acidosis, and following administration of betamethasone.…”

Section: Plasma Osmolality and Sodiummentioning

confidence: 99%

Review article: Investigations and the pregnant woman in the emergency department – part 1: Laboratory investigations

Morton

Teasdale

2018

Emerg Medicine Australasia

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Accurate assessment of the pregnant patient in the ED depends on knowledge of physiological changes in pregnancy, and how these changes may impact on pathology tests, appearance on point‐of‐care ultrasound and electrocardiography. In addition the emergency physician needs to be cognisant of disorders that are unique to or more common in pregnancy. Part 1 of this review addresses potential deviations in laboratory investigation reference intervals resulting from physiological alterations in pregnancy, and the important causes of abnormal laboratory results in pregnancy. Part 2 will address the role of point‐of‐care ultrasound in pregnancy, physiological changes that may affect interpretation of point‐of‐care ultrasound, physiological changes in electrocardiography, and the safety of radiological procedures in the pregnant patient.

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Rhabdomyolysis After Hyperemesis Gravidarum

Abstract: Pregnancies complicated by hyperemesis gravidarum represent potentially high-risk clinical scenarios for electrolyte abnormalities and subsequent complications, including rhabdomyolysis.

Cited by 29 publications

References 6 publications

Hyperemesis Gravidarum: A Review of Recent Literature

Hyperemesis Gravidarum: A Review of Recent Literature

Hyperemesis gravidarum followed by refeeding syndrome causes electrolyte abnormalities induced rhabdomyolysis and diabetes insipidus

Review article: Investigations and the pregnant woman in the emergency department – part 1: Laboratory investigations

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