Rhabdomyolysis in diabetic emergencies

Abstract

Rhabdomyolysis (RM) is a clinical and laboratory syndrome resulting from leakage of muscle cell contents into plasma. The increased plasma concentration of the substances released such as creatine kinase (CK) permits the clinician to diagnose this syndrome. Non-traumatic RM has occasionally been reported in patients with diabetic decompensation. We encountered about 44 cases of RM in 265 diabetic emergencies (including DKA or hyperosmolar, or both) during the period from 1984-1 to 1990-6, diagnosed based on (1) serum creatine kinase (CK) > 1000 IU/l and (2) the absence of acute myocardial infarction, stroke and end-stage renal disease. On admission, those who presented with RM had significantly higher concentration of blood urine nitrogen (BUN) (83.3 ± 5.9 vs 58.8 ±2.4 mg/dl, P < 0.05), creatine (4.45 ± 0.4 vs. 2.97 ± 0.1 mg/dl, P < 0.05) and serum osmolarity (386.5 ± 5.2 vs. 351.6 ± 2.4 mOsm/kg, P < 0.05). The mortality within 1 week of diabetic emergencies (38.5% for DKA, 35.5% for HHNK) was higher in patients with RM than those without RM (9.7% for DKA, 26.7% for HHNK). There was a correlation ( r = 0.49, P < 0.05) between the levels of serum creatinine and CK in patients with RM. It is concluded that (1) diagnosis of RM in diabetic emergency is easy by use of screening examination of serum CK levels, (2) subclinical RM is a common finding in hyperosmolar status, (3) RM is not uncommonly seen in diabetic emergency and early diagnosis is important because of its higher mortality rate (38.5% for DKA and 35.5% for HHNK), (4) CK values in diabetic emergency tend to increase in RM patients if acute renal failure coexists.