title: Rhabdomyolysis in diabetic ketoacidosis.
abstract: Rhabdomyolysis is a potentially lethal disorder, characterized by elevated serum concentrations of creatine kinase (CK) due to skeletal muscle injury. In this paper a patient with diabetic ketoacidosis (DKA) is reported who developed rhabdomyolysis (maximum CK level, 37,700 U/L; normal, < 170 U/L), anemia (6.2 g/dL) and thrombocytopenia (16,000/microL). This combination of rhabdomyolysis with anemia and thrombocytopenia has not yet been reported in DKA. The pathogenic mechanism leading to rhabdomyolysis in DKA remains unsettled. From the literature it seems that those patients who develop rhabdomyolysis have very high glucose levels and a high osmolality on admission. Low phosphate levels can play a role as well. The etiology of anemia and thrombocytopenia in our patient remains obscure. Intravascular hemolysis could not be demonstrated but intramedullar hemolysis, due to osmolar shift or hypophosphatemia, cannot be excluded. A review of the literature data revealed that rhabdomyolysis is not so uncommon in DKA. However, to obtain incidence data in children, prospective studies are necessary.
authors.affiliation: Department of Pediatrics, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium. Kristina.Casteels@uz.kuleuven.ac.be
authors.forename: Kristina
authors.initials: K
authors.lastname: Casteels
authors.forename: Dominique
authors.initials: D
authors.lastname: Beckers
authors.forename: Carine
authors.initials: C
authors.lastname: Wouters
authors.forename: Chris
authors.initials: C
authors.lastname: Van Geet
mesh_terms: D000740:Anemia / Q000150:complications; D001769:Blood; D001786:Blood Glucose / Q000032:analysis; D003402:Creatine Kinase / Q000097:blood; D016883:Diabetic Ketoacidosis / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D009994:Osmolar Concentration; D010710:Phosphates / Q000097:blood; D012206:Rhabdomyolysis / Q000150:complications* / Q000175:diagnosis; D013921:Thrombocytopenia / Q000150:complications
chemical_list: D001786:Blood Glucose; D010710:Phosphates; D003402:Creatine Kinase