Extreme hypernatremia combined with rhabdomyolysis and acute renal failure.
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.
Yang
Tzu-Ying
TY
Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Chang
Jei-Wen
JW
Tseng
Min-Hua
MH
Wang
Hsin-Hui
HH
Niu
Dau-Ming
DM
Yang
Ling-Yu
LY
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