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Rhabdomyolysis in diabetic ketoacidosis
Author(s) -
Casteels Kristina,
Beckers Dominique,
Wouters Carine,
Van Geet Chris
Publication year - 2003
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1034/j.1399-5448.2003.00026.x
Subject(s) - rhabdomyolysis , medicine , diabetic ketoacidosis , hypophosphatemia , hemolysis , anemia , diabetes mellitus , etiology , ketoacidosis , creatine kinase , fulminant , gastroenterology , type 1 diabetes , endocrinology
Rhabdomyolysis is a potentially lethal disorder, characterized by elevated serum concentrations of creatine kinase (CK) due to skeletal muscle injury. In this paper a patient with diabetic ketoacidosis (DKA) is reported who developed rhabdomyolysis (maximum CK level, 37 700 U/L; normal, < 170 U/L), anemia (6.2 g/dL) and thrombocytopenia (16 000/µL). This combination of rhabdomyolysis with anemia and thrombocytopenia has not yet been reported in DKA. The pathogenic mechanism leading to rhabdomyolysis in DKA remains unsettled. From the literature it seems that those patients who develop rhabdomyolysis have very high glucose levels and a high osmolality on admission. Low phosphate levels can play a role as well. The etiology of anemia and thrombocytopenia in our patient remains obscure. Intravascular hemolysis could not be demonstrated but intramedullar hemolysis, due to osmolar shift or hypophosphatemia, cannot be excluded. A review of the literature data revealed that rhabdomyolysis is not so uncommon in DKA. However, to obtain incidence data in children, prospective studies are necessary.