Objective To investigate the clinical characteristics and treatment strategies of diabetic hyperosmolar hyperglycemia (HHS) with rhabdomyolysis (RM). Methods The clinical data of 40 patients with HHS treated in the General Hospital of Shenyang Military Command from November 2013 to November 2017 were retrospectively analyzed.According to the serum levels of creatine phosphokinase and myoglobin, they were divided into RM group (12 cases) and non-RM group (28 cases). The clinical characteristics and treatment results of the two groups were compared. Results There were 12 cases in the RM group, 6 cases were diagnosed RM at the time of consultation, and 6 cases developed RM during the course of treatment.Compared with the non-RM group, RM group had lower systolic pressure[(98.3±17.8)mmHg vs.(128.0±18.1)mmHg, t=4.823, P=0.000], higher blood glucose level[(44.4±14.0)mmol/L vs.(32.6±8.1)mmol/L, t=2.717, P=0.016], and more acidosis, mainly manifested by lower pH[(7.16±0.15)vs.(7.32±0.13), t=3.355, P=0.002], lower bicarbonate[(12.92±5.23)mmol/L vs.(19.07±6.80)mmol/L, t=2.792, P=0.008], higher blood D-3 hydroxybutyric acid [(5.84±2.98)mmol/L vs.(2.55±2.13)mmol/L, t=4.012, P=0.000], and renal function was worse[creatinine (257.1±149.8)μmol/L vs.(148.1±85.3)μmol/L, t=2.925, P=0.006]. Individualized rehydration and low dose insulin were given to control blood sugar, and increasing blood pressure, kidney protection, correction of electrolyte disturbance, anti-infection and inhibition of gland secretion were given to the complications.Hydration and alkalization were given to 7 cases of RM, and continuous renal replacement therapy (CRRT) was given to 5 cases.In 10 cases of HHS with RM, creatine kinase decreased, renal function recovered, and 2 patients died. Conclusion It is very important to improve the understanding of RM in HHS patients, routinely monitor the dynamic changes of muscle enzymes, make a good early diagnosis and prevention of RM.Urine hydration and alkalization should be given in time after RM occurs, and CRRT treatment as early as possible can improve the survival rate of diabetic patients. Key words: Diabetes mellitus; Hyperglycemic hyperosmolar nonketotic coma; Diabetic ketoacidosis; Rhabdomyolysis; Creatine kinase; Myoglobin; Acute kidney injury; Rehydration solutions; Renal replacement therapy; Retrospective studies