Acute Renal Failure in Rhabdomyolysis Associated with Hypokalemia

Angelo Lucatello, MD, Divisione di Nefrologia e Dialisi, Ospedale Civile ‘S. Maria delle Croci’, Via Missiroli, 10, I-48100 Ravenna (Italy) Dear Sir, It is well known that nontraumatic rhabdomyolysis (NR) has several causes [1] and complicates up to 33% of cases with acute renal failure (ARF). We report on 2 patients who developed ARF, due to NR and associated to hypokalemia and ileus, after a prolonged period of immobilization because of neurologic or psychiatric pathology. Patient 1: A. 51-year-old male was admitted to a department of internal medicine because of a short loss of consciousness. The patient had been taking low-dose neuroleptics for a psychiatric pathology for some years. Physical examination showed: temperature 37.5 °C; heart rate 120 beats/min, and blood pressure 130/90 mm Hg. Standard ECG disclosed an atrial flutter. There was a diffuse swelling of the abdomen with marked pain and no peristalsis. On rectal examination there was no stool. Initial laboratory values are shown in table 1. Oligoanuría was present. Therapy was started with intravenous fluids, sodium bicarbonate, potassium aspartate and the association of a continuous intravenous infusion of subpharmacological doses of do-pamine (3 μg/kg/min) plus an intravenous bolus of frusemide (60 mg) 3 times/day [2]. On the following days azotemia progressed and it was necessary to start hemodialysis on the 4th hospital day. Nine hemodialyses were performed. The normal range of serum potassium was achieved on the 10th day, ileus resolved completely on the 16th day and normal renal function was reached on the 20th hospital day. Patient 2: A 46-year-old male was admitted to the emergency unit comatose and with hyperosmolar syndrome. Cerebral CT disclosed a mesencephalic hemorrhage. Examination revealed paralysis of arms and legs with absence of deep reflexes. Temperature was 37.2 °C, heart rate 130 beats/min and blood pressure 100/60 mm Hg. The abdomen was swollen and hypertympanic. Peristalsis was absent. Rectal examination revealed no stool. Initial laboratory values are shown in table 1. Therapy was started with intravenous fluids, sodium bicarbonate, potassium aspartate, dopamine at subpharmacological doses and a bolus of frusemide 3 times/day [2]. On the following days, azotemia progressed, oligoanuría developed and it was necessary to start hemodialysis. Oligoanuría persisted for 11 days during which 10 hemodialytic treatments were performed. Serum potassium reached normal