Rhabdomyolysis after cerebral perfusion pressure-guided management in severe head injury.
Intravenous infusion of norepinephrine is usually effective and safe to maintain adequate cerebral perfusion pressure for the management of posttraumatic intracranial hypertension. We report the case of a 17-year-old woman who suffered from traumatic intracranial bleeding and hypotension; she developed rhabdomyolysis, myoglobinuria and acute renal failure after receiving high dose norepinephrine postoperatively. Hemodialysis was begun 3 days after the onset of myoglobinuria when acute renal failure was noted, despite aggressive fluid supplementation and alkaline diuresis. After aggressive treatment and dialysis, the patient's myoglobinuria and rhabdomyolysis gradually declined. Her kidneys eventually regained normal function. We consider that systemic hypotension may have been the leading cause for development of rhabdomyolysis, and vasoconstrictors such as norepinephrine aggravated this. We emphasise the potentially devastating consequences of rhabdomyolysis when a large dose of norepinephrine is given for the treatment of hypotension during cerebral perfusion pressure-guided management.
Sung
Kuan-Chin
KC
Department of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan 710, Taiwan.
Kuo
Jinn-Rung
JR
Yeh
Tsong-Chih
TC
Chio
Chung-Ching
CC
D000063:Accidents, Traffic; D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology; D002560:Cerebrovascular Circulation; D006259:Craniocerebral Trauma / Q000150:complications / Q000628:therapy*; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D000860:Hypoxia / Q000097:blood; D007677:Kidney Function Tests; D010477:Perfusion; D006435:Renal Dialysis; D012121:Respiration, Artificial; D012206:Rhabdomyolysis / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed
D003402:Creatine Kinase