title: Extreme hypernatremia combined with rhabdomyolysis and acute renal failure.
abstract: Rhabdomyolysis is a life-threatening condition that involves muscle cell destruction. Among its etiologies, severe hypernatremia is a less common cause. We report a teenage girl with congenital central hypoventilation syndrome and hypothalamus dysfunction syndrome who presented with extreme hypernatremia (sodium, 211 mmol/L) with rhabdomyolysis (creatine kinase, 32,850 U/L) and acute renal failure (creatinine, 6.1 mg/dL) following gastroenteritis with 7-kg weight loss. Rhabdomyolysis subsequently led to acute renal failure and hyperkalemia. Acute hemodialysis was initiated on hospital day 3 for hyperkalemia. This resulted in a 13 mmol/L fall in serum sodium in 3 hours despite using a 156 mmol/L sodium bath, but without the development of cerebral edema or neurological defect. This report highlights an unusual cause of rhabdomyolysis in children and the experience of managing such a difficult clinical situation.
authors.affiliation: Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Tzu-Ying
authors.initials: TY
authors.lastname: Yang
authors.forename: Jei-Wen
authors.initials: JW
authors.lastname: Chang
authors.forename: Min-Hua
authors.initials: MH
authors.lastname: Tseng
authors.forename: Hsin-Hui
authors.initials: HH
authors.lastname: Wang
authors.forename: Dau-Ming
authors.initials: DM
authors.lastname: Niu
authors.forename: Ling-Yu
authors.initials: LY
authors.lastname: Yang
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D002648:Child; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000150:complications*; D007031:Hypothalamus / Q000503:physiopathology; D012206:Rhabdomyolysis / Q000209:etiology*; D020182:Sleep Apnea, Central / Q000150:complications