title: Rhabdomyolysis Due to Severe Hypophosphatemia in Diabetic Ketoacidosis.
abstract: Rhabdomyolysis is a syndrome characterized by injury to skeletal muscle fibers with disruption and release of toxic metabolites into circulation. It is characterized by triad of muscle weakness, myalgia and dark urine and is associated with increased creatine kinase and lactate dehydrogenase. A severely malnourished 10 year old girl with severe diabetic ketoacidosis as hemr initial presentation of type 1 diabetes mellitus developed rhabdomyolysis (CK- 12,000 U/L) with non-oliguric renal failure during her initial course of hospital stay. The possible cause of her RM was attributed to severe hypophosphatemia (minimum serum phosphate, 0.8 mg/dL). Management of diabetic ketoacidosis phosphate supplementation and urinary alkalinization with diuresis improved her clinical course. She was discharged on Day 9 with Insulin. We recommend frequent monitoring of serum phosphate during early period of DKA, particularly in malnourished children, and its normalization in case of severe hypophosphatemia.
authors.affiliation: B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: S K
authors.initials: SK
authors.lastname: Shah
authors.affiliation: B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: L
authors.initials: L
authors.lastname: Shah
authors.affiliation: B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: S
authors.initials: S
authors.lastname: Bhattarai
authors.affiliation: B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: M
authors.initials: M
authors.lastname: Giri
mesh_terms: D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis; D016883:Diabetic Ketoacidosis / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D017674:Hypophosphatemia / Q000150:complications* / Q000628:therapy; D007328:Insulin / Q000627:therapeutic use; D010710:Phosphates / Q000627:therapeutic use; D012206:Rhabdomyolysis / Q000209:etiology* / Q000628:therapy; D012720:Severity of Illness Index; D017693:Sodium Bicarbonate / Q000627:therapeutic use
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D010710:Phosphates; D017693:Sodium Bicarbonate
keywords: diabetic ketoacidosis; hypophosphatemia; malnutrition; renal failure; rhabdomyolysis.