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1
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Mathew DM, Chilakala A, Elfert K. Rhabdomyolysis in the Setting of Severe Hyponatremia: A Case Report. Cureus 2023; 15:e39993. [PMID: 37416016 PMCID: PMC10321562 DOI: 10.7759/cureus.39993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Electrolyte imbalances are common problems among hospitalized patients, and they can have severe consequences. Although rare, severe hyponatremia or low sodium (Na) levels have been associated with the occurrence of rhabdomyolysis. This is a case of a 45-year-old man who presented with confusion and lethargy and was found to have severe hyponatremia with an elevated creatine phosphokinase (CPK) level of 45,440 IU/L. With the administration of normal saline, the Na levels and CPK improved. He was discharged from the hospital in stable clinical condition. This case demonstrates the need for providers to monitor rhabdomyolysis markers in severe hyponatremia, as there is an observed association between the two and the sequelae can be severe.
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Affiliation(s)
- Diana M Mathew
- Internal Medicine, City University of New York (CUNY) School of Medicine, New York City, USA
| | - Akhila Chilakala
- Internal Medicine, City University of New York (CUNY) School of Medicine, New York City, USA
| | - Khaled Elfert
- Internal Medicine, St. Barnabas Hospital Health System, New York City, USA
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Takenouchi H, Anno T, Kimura Y, Kawasaki F, Shirai R, Kaneto H, Kurokawa K, Tomoda K. Case Report: A Patient With Neuroleptic Malignant Syndrome, Water Intoxication and Hyponatremia Associated With Severe Cerebral Edema and Coma. Front Endocrinol (Lausanne) 2022; 13:822679. [PMID: 35360072 PMCID: PMC8960374 DOI: 10.3389/fendo.2022.822679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Water intoxication is typically caused by primary or psychogenic polydipsia that potentially may lead to fatal disturbance in brain functions. Neuroleptic malignant syndrome (NMS) is a serious complication induced by administration of antipsychotics and other psychotropic drugs. The combination of inappropriate secretion of antidiuretic hormone (SIDAH), NMS and rhabdomyolysis have been rarely reported. Our patient also developed severe water intoxication. CASE PRESENTATION Herein we report a comatose case of NMS complicated with water intoxication, syndrome of SIADH and rhabdomyolysis. This patient had severe cerebral edema and hyponatremia that were improved rapidly by the correction of hyponatremia within a couple of days. CONCLUSIONS Malignant neuroleptic syndrome water intoxication, SIADH and rhabdomyolysis can occur simultaneously. Comatose conditions induced by cerebral edema and hyponatremia can be successfully treated by meticulous fluid management and the correction of hyponatremia.
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Affiliation(s)
- Haruka Takenouchi
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Takatoshi Anno
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
- *Correspondence: Takatoshi Anno,
| | - Yukiko Kimura
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Fumiko Kawasaki
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Ryo Shirai
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Katsumi Kurokawa
- Department of Neurology, Kawasaki Medical School, Okayama, Japan
| | - Koichi Tomoda
- Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan
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Rangan GK, Dorani N, Zhang MM, Abu-Zarour L, Lau HC, Munt A, Chandra AN, Saravanabavan S, Rangan A, Zhang JQJ, Howell M, Wong AT. Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review. BMJ Open 2021; 11:e046539. [PMID: 34887267 PMCID: PMC8663108 DOI: 10.1136/bmjopen-2020-046539] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/10/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Excessive water intake is rarely associated with life-threatening hyponatraemia. The aim of this study was to determine the clinical characteristics and outcomes of hyponatraemia associated with excess water intake. METHODS This review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies (case reports, observational or interventional studies) reporting excess water intake and hyponatraemia in adults (1946-2019) were included. RESULTS A total of 2970 articles were identified and 177 were included (88.7% case reports), consisting of 590 patients. The mean age was 46±16 years (95% CI 44 to 48 years), 47% female, 52% had a chronic psychiatric disorder and 31% had no underlying condition. The median volume of water consumed and serum sodium at presentation was 8 L/day (95% CI 8.9 to 12.2 L/day) and 118 mmol/L (95% CI 116 to 118 mmol/L), respectively. The motivator for increased water consumption was psychogenic polydipsia (55%); iatrogenic (13%); exercise (12%); habitual/dipsogenic polydipsia (7%) and other reasons (13%). The clinical features on presentation were severe in 53% (seizures, coma); moderate in 35% (confusion, vomiting, agitation) and mild in 5% (dizziness, lethargy, cognitive deficit) and not reported in 5% of studies. Treatment was supportive in 41% of studies (fluid restriction, treatment of the underlying cause, emergency care), and isotonic and hypertonic saline was used in 18% and 28% of cases, respectively. Treatment-related complications included osmotic demyelination (3%) and rhabdomyolysis (7%), and death occurred in 13% of cases. CONCLUSION Water intoxication is associated with significant morbidity and mortality and requires daily intake to substantially exceed population-based recommendations. The limitations of this analysis are the low quality and high risk of bias of the included studies. PROSPERO REGISTRATION NUMBER A pre-existing protocol in the international prospective register of systematic reviews was updated to incorporate any new amendments and reregistered at http://www.crd.york.ac.uk/PROSPERO (registration no. CRD42019129809).
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Affiliation(s)
- Gopala K Rangan
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Nilofar Dorani
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Miranda M Zhang
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lara Abu-Zarour
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ho Ching Lau
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- School of Life and Environmental Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alexandra Munt
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ashley N Chandra
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sayanthooran Saravanabavan
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Anna Rangan
- Nutrition and Dietetics, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Q J Zhang
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Martin Howell
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Annette Ty Wong
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
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Kirino S, Sakuma M, Misawa F, Fujii Y, Uchida H, Mimura M, Takeuchi H. Relationship between polydipsia and antipsychotics: A systematic review of clinical studies and case reports. Prog Neuropsychopharmacol Biol Psychiatry 2020; 96:109756. [PMID: 31472167 DOI: 10.1016/j.pnpbp.2019.109756] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This systematic review aimed to elucidate the relationship between polydipsia and antipsychotics. METHODS We systematically searched MEDLINE, Embase, and PsycINFO, and included clinical studies and case reports on polydipsia induced or improved by antipsychotics. RESULTS We identified 61 articles: 1 double-blind randomized controlled trial (RCT), 4 single-arm trials, 1 cross-sectional study, 3 case series, and 52 case reports. The double-blind RCT demonstrated no significant difference in improvement in polydipsia between olanzapine and haloperidol. Two single-arm trials showed that polydipsia improved during clozapine treatment, whereas the other 2 showed that risperidone did not improve polydipsia. The cross-sectional study showed the prevalence of hyponatremia with first-generation antipsychotics (FGAs: 26.1%) and second-generation antipsychotics (SGAs: 4.9%). Two case series reported that clozapine improved polydipsia; the other one indicated that patients with polydipsia who were treated with FGAs had schizophrenia (70.4%) and mental retardation (25.9%). Of 90 cases in the case reports, 67 (75.3%) were diagnosed with schizophrenia. Of 83 cases in which antipsychotic treatment started before the onset of polydipsia, 75 (90.3%) received FGAs, particularly haloperidol (n = 24, 28.9%), and 11 (13.3%) received risperidone. Among 40 cases in which polydipsia was improved following antipsychotic treatment, 36 (90.0%) received SGAs, primarily clozapine (n = 14, 35.0%). CONCLUSIONS Although the causal relationship between polydipsia and antipsychotics remains unclear because of the paucity of high-quality studies, antipsychotics with high affinity to dopamine D2 receptors may be associated with an increased risk of polydipsia while clozapine may be effective for treating polydipsia.
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Affiliation(s)
- So Kirino
- Yamanashi Prefectural Kita Hospital, Yamanashi, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Mutsuki Sakuma
- Yamanashi Prefectural Kita Hospital, Yamanashi, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | - Yasuo Fujii
- Yamanashi Prefectural Kita Hospital, Yamanashi, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyoshi Takeuchi
- Yamanashi Prefectural Kita Hospital, Yamanashi, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
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Fernando S, Sivagnanam F, Rathish D. A compulsive act of excess water intake leading to hyponatraemia and rhabdomyolysis: a case report. Int J Emerg Med 2019; 12:34. [PMID: 31726974 PMCID: PMC6854615 DOI: 10.1186/s12245-019-0255-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/29/2019] [Indexed: 11/26/2022] Open
Abstract
Background Primary polydipsia is commonly seen in patients with psychiatric illnesses. Excess water intake is also seen in patient with anorexia and anticholinergic medications. We report a patient who had hyponatraemia and rhabdomyolysis after consuming excess water for ureteric calculus. Case presentation A healthy middle-aged male presented with an episode of generalized tonic-clonic seizure and reduced level of consciousness preceded by consumption of excess water. He was recently diagnosed to have a ureteric calculus and was advised to consume plenty of water. On examination, he was disoriented in place, person and time. Except for the generalized diminished reflexes, other neurological and systemic examinations were normal. He had severe hyponatraemia, mild hypokalaemia and myoglobulinuria. His serum creatinine phosphokinase and aspartate aminotransferase were markedly elevated. The diagnosis of rhabdomyolysis in the setting of acute water intoxication was made. Optimum fluid and electrolyte management achieved a dramatic recovery of consciousness, hyponatraemia and rhabdomyolysis. Discussion The patient has had excess water intake due to a compulsive act in the background fear of ureteric calculus. Such act could lead to severe hyponatraemia and rhabdomyolysis. Therefore, future similar acts could be prevented by proper medical advice. Further, emergency physicians should be vigilant for rhabdomyolysis in patients with hyponatraemia or hypokalaemia.
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Affiliation(s)
| | | | - Devarajan Rathish
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
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Yang HJ, Cheng WJ. Antipsychotic use is a risk factor for hyponatremia in patients with schizophrenia: a 15-year follow-up study. Psychopharmacology (Berl) 2017; 234:869-876. [PMID: 28078393 DOI: 10.1007/s00213-017-4525-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/02/2017] [Indexed: 01/05/2023]
Abstract
RATIONALE Hyponatremia affects 10% of patients with chronic schizophrenia and can lead to severe consequences. However, the role of antipsychotics and other risk factors in hyponatremia occurrence has remained inconsistent. OBJECTIVE This study examined the association between antipsychotic use and hyponatremia occurrence in patients with schizophrenia. METHODS We utilized the National Health Insurance Research Database to follow 2051 patients with schizophrenia from 1998 to 2013. Among them, 137 (6.7%) developed hyponatremia. Sociodemographic characteristics, physical comorbidities, and psychiatric treatment experiences were compared between those who had hyponatremia and those who did not. A Cox proportional hazards model was used to examine the hazard ratios (HRs) of these characteristics. RESULTS In patients with hyponatremia, the mean age at first hyponatremia occurrence was 54.7 ± 13.9 years, an average of 9.5 ± 4.0 years after schizophrenia diagnosis, and 32.9% of them were off antipsychotics before hyponatremia occurrences. Age at schizophrenia diagnosis (HR = 1.1), low-income household (HR = 2.4), comorbidities (HR = 1.2), and psychiatric admissions (HR = 1.04) were associated with the risks of hyponatremia. Compared with no antipsychotic use, atypical (HR = 2.1) and typical antipsychotics (HR = 3.1) were associated with an elevated risk of hyponatremia, after adjustment for age, sex, and physical comorbidities. Carbamazepine use (HR = 2.9) was also a significant risk factor for hyponatremia (p < 0.05). CONCLUSIONS Antipsychotic use in patients with schizophrenia with polypharmacy should be monitored for hyponatremia occurrences. Clinicians should pay attention to the impact of poor living conditions on hyponatremia occurrence.
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Affiliation(s)
- Hang-Ju Yang
- Department of Emergency Medicine, Jen-Ai Hospital, 483 Dong Rong Road, Taichung, 41265, Taiwan
| | - Wan-Ju Cheng
- Department of Psychiatry, China Medical University Hospital, 2 Yude Road, Taichung, 40447, Taiwan. .,Department of Public Health, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan.
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Zaman MO, Greenberg E, Khan QA, Jan N, Bashir S, Mojadidi MK. Unilateral Acute Anterior Compartment Syndrome from Correction of Psychogenic Polydipsia-Induced Hyponatremia. Am J Med 2016; 129:e285-e286. [PMID: 27427324 DOI: 10.1016/j.amjmed.2016.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 06/05/2016] [Accepted: 06/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ethan Greenberg
- Department of Medicine, Crozer Chester Medical Center, Upland, Pa
| | - Qalb Abbas Khan
- Department of Medicine, Crozer Chester Medical Center, Upland, Pa
| | - Naveedullah Jan
- Department of Medicine, Crozer Chester Medical Center, Upland, Pa
| | - Sania Bashir
- Department of Medicine, Crozer Chester Medical Center, Upland, Pa
| | - Mohammad Khalid Mojadidi
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville.
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Dubin I, Gelber M, Schattner A. Rare times rare: The hyponatremia, rhabdomyolysis, anterior compartment syndrome sequence. JRSM Open 2016; 7:2054270416629326. [PMID: 27186379 PMCID: PMC4858724 DOI: 10.1177/2054270416629326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Primary polydipsia occurs in up to 25% of patients with chronic psychiatric disorders (especially schizophrenia), related to the disease, its treatment or both. Urine output fails to match intake >10 L/day and water intoxication may develop. Rhabdomyolysis is a rare complication of hyponatremia, and an acute anterior compartment syndrome of the leg, an emergency, may be very rarely associated.
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Affiliation(s)
- Ina Dubin
- Department of Medicine, Laniado Hospital, Sanz Medical Center, Netanya
| | - Moshe Gelber
- Department of Medicine, Laniado Hospital, Sanz Medical Center, Netanya
| | - Ami Schattner
- Department of Medicine, Laniado Hospital, Sanz Medical Center, Netanya; Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel
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Cairns RS, Hew-Butler T. Proof of concept: hypovolemic hyponatremia may precede and augment creatine kinase elevations during an ultramarathon. Eur J Appl Physiol 2016; 116:647-55. [PMID: 26747653 DOI: 10.1007/s00421-015-3324-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/20/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE It is not known if exercise-associated hyponatremia (EAH) is a cause or consequence of exertional rhabdomyolysis (ER).We hypothesized that osmotic stress (EAH) coupled with mechanical stress (running) potentiated muscle cell breakdown (ER). This concept would be supported if a nadir in serum sodium concentration ([Na(+)]) temporally preceded peak creatine kinase levels (CK) during an ultramarathon run. METHODS Fifteen participants ran ≥104 km and had blood drawn: prior to start; 53; 104 km; and 24-h post run. Serum [Na(+)], CK, urea, creatinine and estimated glomerular filtration rate (eGFR) were measured from serial blood samples. Two-way repeated-measures ANOVA was used to examine differences regarding both race distance and natremia status. RESULTS Ten of 15 participants demonstrated EAH (serum [Na(+)] <135 mmol/L) at least once during serial testing. Participants were categorized post hoc into one of three natremia groups based on lowest recorded [Na(+)]: (1) <129 mmol/L (n = 3; moderate EAH); (2) between 129 and 134 mmol/L (n = 7; mild EAH); and (3) >134 mmol/L (n = 5; normonatremia). Participants with lowest [Na(+)] demonstrated highest CK values at subsequent checkpoints. Significant natremia group differences noted at the 53 km point (p = 0.0002) for [Na(+)] while significant natremia group effect noted for CK seen at the 24-h post-finish testing point (p = 0.02). Significant natremia group effects noted for renal biomarkers, with the moderate EAH group documenting the lowest eGFR (p = 0.005), and highest serum urea (p = 0.0006) and creatinine (p < 0.0001) levels. Hyponatremic runners had lower post-race urine [Na(+)] than normonatremic runners (26 ± 15 vs. 89 ± 79 mmol/L; p = 0.03). CONCLUSIONS Preliminary data support the possibility that transient hypovolemic EAH may precede and augment CK during an ultramarathon.
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Affiliation(s)
- Ross S Cairns
- Newcastle Sports Medicine, New Lambton, New South Wales, Australia
| | - Tamara Hew-Butler
- School of Health Science, 3157HHB, Oakland University, Rochester, MI, 48309-4482, USA.
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Restrepo D, Montoya P, Giraldo L, Gaviria G, Mejía C. [Rhabdomyolysis in a Bipolar Adolescent. Analysis of Associated Factors]. REVISTA COLOMBIANA DE PSIQUIATRIA 2015; 44:183-8. [PMID: 26578419 DOI: 10.1016/j.rcp.2015.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To describe a case of rhabdomyolysis associated with the use of quetiapine and lamotrigine in an adolescent treated for bipolar disorder. METHOD Description of the clinical case, analysis of the associated factors and a non-systematic review of the relevant literature. RESULTS An 18 year old male, with bipolar disorder and treated pharmacologically with quetiapine and lamotrigine, after two weeks of physical activity presents with rhabdomyolysis. Quetiapine and exercise have been associated with rhabdomyolysis. The mediator mechanism of this association has not been found, although it has been established that there is neuromuscular dysfunction and an increase in sarcomere permeability. CONCLUSIONS This clinical case allowed the complex interaction between antipsychotic agents and increased physical activity to be observed in a psychiatric adolescent patient, as well as the appearance of a potentially lethal medical complication.
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Ulstrup A, Ugleholdt R, Rasmussen JV. Fulminant crural compartment syndrome preceded by psychogenic polydipsia. BMJ Case Rep 2015; 2015:bcr-2014-208603. [PMID: 25976194 DOI: 10.1136/bcr-2014-208603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of bilateral anterolateral crural compartment syndrome elicited by hyponatraemia and psychogenic polydipsia. The unusual constellation of clinical findings and diminished pain expression made initial diagnostic procedures challenging. The possible pathogenesis and treatment options are discussed. Impairment of lower extremity function at follow-up was serious and permanent.
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Affiliation(s)
- Anton Ulstrup
- Department of Orthopaedic Surgery, Herlev University Hospital, Copenhagen, Denmark
| | - Randi Ugleholdt
- Department of Medicine, Herlev University Hospital, Copenhagen, Denmark
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12
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Aguiar DT, Monteiro C, Coutinho P. Recurrent rhabdomyolysis secondary to hyponatremia in a patient with primary psychogenic polydipsia. Rev Bras Ter Intensiva 2015; 27:77-81. [PMID: 25909317 PMCID: PMC4396901 DOI: 10.5935/0103-507x.20150013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/06/2015] [Indexed: 11/20/2022] Open
Abstract
Rhabdomyolysis is characterized by the destruction of skeletal muscle tissue, and its
main causes are trauma, toxic substances and electrolyte disturbances. Among the
latter is hyponatremia-induced rhabdomyolysis, a rare condition that occurs mainly in
patients with psychogenic polydipsia. Psycogenic polydipsia mostly affects patients
with schizophrenia, coursing with hyponatremia in almost 25% of the cases. It is also
in this context that rhabdomyolysis secondary to hyponatremia occurs most often. In
this article, the case of a 49-year-old male with a history of schizophrenia,
medicated with clozapine, and brought to the emergency room in a state of coma and
seizures is described. Severe hypoosmolar hyponatremia with cerebral edema was found
on a computed tomography examination, and a subsequent diagnosis of hyponatremia
secondary to psychogenic polydipsia was made. Hyponatremia correction therapy was
started, and the patient was admitted to the intensive care unit. After the
hyponatremia correction, the patient presented with analytical worsening, showing
marked rhabdomyolysis with a creatine phosphokinase level of 44.058UI/L on day 3 of
hospitalization. The condition showed a subsequent progressive improvement with
therapy, with no occurrence of kidney damage. This case stresses the need for
monitoring rhabdomyolysis markers in severe hyponatremia, illustrating the condition
of rhabdomyolysis secondary to hyponatremia induced by psychogenic polydipsia, which
should be considered in patients undergoing treatment with neuroleptics.
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Affiliation(s)
- Diana Tavares Aguiar
- Serviço de Medicina Interna, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Catarina Monteiro
- Serviço de Medicina Interna, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Coutinho
- Serviço de Medicina Interna, Hospital Geral, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Abstract
OBJECTIVE To report a case of recurrent hyponatremia and rhabdomyolysis in a teenager with psychogenic polydipsia. CASE SUMMARY A 16-year-old boy was admitted with recurrent episodes of hyponatremia and rhabdomyolysis secondary to psychogenic polydipsia. He was treated with hypertonic saline, intravenous fluids, and supportive care. DISCUSSION Psychogenic polydipsia is a condition characterized by compulsive drinking. Severe hyponatremia is a rare, but serious complication in patients with psychogenic polydipsia. Failure in cell volume regulatory mechanisms, defective osmoregulation, defective urinary dilution, and enhanced secretion of vasopressin are believed to play a role in the development of hyponatremia. Rhabdomyolysis can complicate severe hyponatremia, although the exact mechanism is not known. Antipsychotic drugs are also implicated in rhabdomyolysis. CONCLUSIONS Severe hyponatremia and rhabdomyolysis can complicate psychogenic polydipsia. Patients receiving antipsychotic drugs with concomitant severe hyponatremia need to be monitored for rhabdomyolysis.
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Chen LC, Bai YM, Chang MH. Polydipsia, hyponatremia and rhabdomyolysis in schizophrenia: A case report. World J Psychiatry 2014; 4:150-152. [PMID: 25540730 PMCID: PMC4274587 DOI: 10.5498/wjp.v4.i4.150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 07/22/2014] [Accepted: 11/19/2014] [Indexed: 02/05/2023] Open
Abstract
The prevalence of polydipsia among patients with schizophrenia is 6%-20%. Around 10%-20% of patients with polydipsia may develop hyponatremia and even complicated with rhabdomyolysis. Here we presented a 40-year-old man with schizophrenia, who had received paliperidone 15 mg/d for more than one year, and polydipsia was noted. In Jan, 2014, he developed hyponatremia (Na 113 mEq/L) with consciousness disturbance. After 3% NaCl (500 cc/d) intravenous supplement for three days, the hyponatremia was corrected, but rhabdomyolysis developed with a substantial elevation in the level of creatine kinase (CK) to 30505 U/L. After hydration, the CK level gradually decreased to 212 U/L. Both the hyponatremia itself and quick supplementation of NaCl can cause rhabdomyolysis. If rhabdomyolysis is not recognized, insufficient hydration or water restriction for polydipsia may further exacerbate the rhabdomyolysis with a lethal risk. In this case, we highlight the possible complication of rhabdomyolysis with polydipsia-induced hyponatremia. In addition to monitoring the serum sodium level, the monitoring of CK is also important; and switching of antipsychotic may improve the polydipsia.
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Sauer F, Lenz A, Popp D, Strecker W. [Compartment syndrome caused by rhabdomyolysis in the context of pychogenic polydipsia]. Unfallchirurg 2014; 118:476-8. [PMID: 25277729 DOI: 10.1007/s00113-014-2640-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Psychogenic polydipsia leading to severe hyponatremia is well documented in the literature. This electrolyte disorder can result in encephalopathy, cerebral edema and epileptic seizures. Another rare effect is rhabdomyolysis with all its well known complications (e.g. renal failure, hyperkalemia and cardiac arrhythmia) and even resulting in compartment syndrome due to severe muscle edema. We present the case of a patient with severe hyponatremia caused by psychogenic polydipsia leading to rhabdomyolysis and compartment syndrome.
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Affiliation(s)
- F Sauer
- Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Bugerstr. 80, 96049, Bamberg, Deutschland,
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Khow KSF, Lau SY, Li JYZ, Yong TY. Asymptomatic elevation of creatine kinase in patients with hyponatremia. Ren Fail 2014; 36:908-11. [PMID: 24673369 DOI: 10.3109/0886022x.2014.900600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Elevated creatine kinase (hyper-CKemia) has been observed in small number of patients with hyponatremia. This study evaluated the features and outcomes of patients admitted with hyponatremia complicated by hyper-CKemia. Patients admitted with hyponatremia and concurrently found to have elevated creatine kinase (CK) of above 375 IU/L (male) or 225 IU/L (female), over a 5-year period were retrospectively reviewed. Those with myocardial injury (elevated CK-MB isoenzyme [CK-MB/CK percentage of >2.5%] or Troponin T [>0.02 μg/L]), traumatic or ischemic muscle damage, primary myopathic disorder, seizures prior to CK measurement or those taking medications which can cause myopathy, were excluded. Thirty-two patients with hyponatremia and hyper-CKemia were identified. All patients had no muscular symptoms or weakness. The commonest cause of hyponatremia in this cohort was related to diuretics (50%). The mean sodium level on presentation was 116.0 ± 6.9 mmol/L and the median peak CK was 895.5 (interquartile range: 610.8-1691.8) IU/L. Six (18%) patients developed acute kidney injury (AKI). The length of hospital admission of the entire cohort was 8.0 ± 5.8 days. Patients with hyper-CKemia in the setting of diuretic-associated hyponatremia were older and had longer hospital length of stay compared with primary-polydipsia-associated. Asymptomatic hyper-CKemia is an uncommon association with hyponatremia of various etiologies. Hyponatremia-associated hyper-CKemia can be complicated by AKI.
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Affiliation(s)
- Kareeann S F Khow
- Department of General Medicine, Flinders Medical Centre , Adelaide , Australia
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Peled M, Dolkart O, Finn T, Amar E, Zeltser D. No association between hyponatremia and rhabdomyolysis in rats. J Emerg Med 2014; 47:472-8. [PMID: 24485700 DOI: 10.1016/j.jemermed.2013.08.086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 07/13/2013] [Accepted: 08/16/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rhabdomyolysis is an uncommon complication of hyponatremia, reported previously only in case reports and small retrospective studies, and its underlying mechanism is controversial. Some studies support the hypothesis that the rapid correction of hyponatremia is responsible for rhabdomyolysis, whereas others emphasize the severity of the hyponatremia as a predisposing factor for rhabdomyolysis. OBJECTIVES To test the association between hyponatremia and rhabdomyolysis and to demonstrate a causal association. METHODS Hyponatremia was induced by administration of water and desmopressin acetate in rats during 3 days, followed by its rapid correction, using animal models established for the evaluation of central pontine myelinolysis. The plasma creatine phosphokinase levels, a marker for rhabdomyolysis, were monitored, and hematoxylin and eosin sections of the quadriceps and gastrocnemius muscles were evaluated for signs of rhabdomyolysis. RESULTS The induction of hyponatremia and its correction were accompanied by the previously reported neurological sequelae, including signs of central pontine myelinolysis. However, no increase in plasma creatine phosphokinase levels was found, and histopathological examination of the quadriceps and gastrocnemius muscles revealed no sign of rhabdomyolysis. CONCLUSIONS The present study, which is the first to test the association between hyponatremia and rhabdomyolysis in an animal model, does not support any causal association between hyponatremia and rhabdomyolysis. Thus, other factors might be necessary for an association between hyponatremia and rhabdomyolysis, such as genetic factors or convulsions that are known to be associated with both hyponatremia and rhabdomyolysis. Further research in this important physiologic and clinical question is needed.
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Affiliation(s)
- Michael Peled
- Department of Internal Medicine, Tel Aviv Sourasky Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oleg Dolkart
- Orthopedic Division, Tel Aviv Sourasky Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Talya Finn
- Department of Internal Medicine, Tel Aviv Sourasky Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Amar
- Orthopedic Division, Tel Aviv Sourasky Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zeltser
- Department of Internal Medicine, Tel Aviv Sourasky Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
Rhabdomyolysis is not a well-understood adverse effect of antipsychotic use. Proposed mechanisms suggest involvement of serotoninergic and/or dopaminergic blockade. The purpose of this study was to describe the relationship between antipsychotic use and rhabdomyolysis. Patients admitted with rhabdomyolysis and taking an antipsychotic from January 2009 to October 2011 were included. Background demographics, laboratory data, medical and physical history, concomitant medications, and hospital course data were collected. Of the 673 cases admitted with rhabdomyolysis, 71 (10.5%) were on an antipsychotic. This is significantly greater when compared to the general US population, where only 1.3% of individuals take an antipsychotic drug ( P < .0001). Cause of rhabdomyolysis was not documented in 38% of cases, and antipsychotic use was suspected in 10% of cases. No significant correlations were found between antipsychotic type and other patient-specific parameters. Seventeen (25%) of these patients were taking 2 or more antipsychotics. The largest percentage was on quetiapine (Seroquel®; AstraZeneca, Wilmington, Delaware), the most commonly prescribed antipsychotic in the United States. Antipsychotic use is a risk factor for rhabdomyolysis and seems to be more common in those taking multiple agents. More research needs to be done to determine which antipsychotics have a higher risk and which receptors are involved. Providers should be aware of rhabdomyolysis associated with antipsychotic use.
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Affiliation(s)
- Kathleen Packard
- School of Pharmacy and Health Professions, Department of Pharmacy Practice, Creighton University, Omaha, NE, USA
| | - Paul Price
- School of Pharmacy and Health Professions, Department of Pharmacy Practice, Creighton University, Omaha, NE, USA
| | - Ashley Hanson
- School of Pharmacy and Health Professions, Department of Pharmacy Practice, Creighton University, Omaha, NE, USA
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Aggarwal R, Guanci N, Marambage K, Caplan JP. A patient with multiple episodes of rhabdomyolysis induced by different neuroleptics. PSYCHOSOMATICS 2013; 55:404-408. [PMID: 24016383 DOI: 10.1016/j.psym.2013.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 05/09/2013] [Accepted: 05/13/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Rashi Aggarwal
- Department of Psychiatry, UMDNJ-New Jersey Medical School, Newark, New Jersey.
| | - Nicole Guanci
- Department of Psychiatry, UMDNJ-New Jersey Medical School, Newark, New Jersey
| | - Kapila Marambage
- Department of Psychiatry, Albert Einstein College of Medicine, Bronx, New York
| | - Jason P Caplan
- Creighton University School of Medicine at St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Maiocchi L, Bernardi E. Acute anterior compartment syndrome associated with psychogenic polydipsia. Australas Psychiatry 2012; 20:159-61. [PMID: 22452903 DOI: 10.1177/1039856211432465] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this paper is to describe the association of psychogenic polydipsia with anterior compartment syndrome. METHOD Case report. RESULTS A 31-year-old man with glucose-6-phosphate-dehydrogenase (G6PD) deficiency had a history of paranoid schizophrenia from age 16 complicated by the use of drugs. Four years after the initial diagnosis of schizophrenia, he developed psychogenic polydipsia. This was complicated by episodic severe acute hyponatraemia with seizures and, on one occasion, by generalized rhabdomyolysis. One episode of severe acute hyponatraemia with delirium led to anterior compartment syndrome in both legs. Delayed diagnosis and treatment led to extensive myonecrosis and permanent bilateral foot drop. For 6 years his polydipsia remained partially controlled in a locked psychiatric ward with limited leave, until his sudden death related to severe water intoxication. CONCLUSIONS Anterior compartment syndrome is a rare event associated with psychogenic polydipsia. Psychiatrists, physicians and surgeons should be aware of the seriousness of anterior compartment syndrome and its potential to increase morbidity in patients with psychogenic polydipsia.
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Bennett M, Fitzpatrick G, Donnelly M. Rhabdomyolysis associated with polydipsia induced hyponatraemia. BMJ Case Rep 2011; 2011:bcr.08.2011.4659. [PMID: 22679167 DOI: 10.1136/bcr.08.2011.4659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A 41-year-old white male with a history of alcoholism and depression was brought from prison into the emergency department (ED) after having had a witnessed tonic-clonic seizure lasting approximately 5 min. During the 24 h prior to admission, the patient's cell mate reported that he was restless and had consumed 11 litres of water. The patient had also been taking regular escitalopram for his depression. On arrival to the ED, the patient was found to have a sodium level of 112 mmol/l. After correction of his hyponatraemia the patient developed rhabdomyolisis with a creatine kinase level of 65 064 IU/l. To prevent an acute kidney injury a high volume alkaline diuresis protocol was started. Once corrected, his sodium level remained normal and he was discharged home after making a full neurological recovery. Rhabdomyolysis has rarely been associated with the correction of hyponatraemia.
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Affiliation(s)
- Michael Bennett
- Emergency Department, Adelaide and Meath incorporating the National Children's Hospital, Dublin, Ireland.
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Katsarou A, Singh S. Hyponatraemia associated rhabdomyolysis following water intoxication. BMJ Case Rep 2010; 2010:2010/sep08_1/bcr0220102720. [PMID: 22778200 DOI: 10.1136/bcr.02.2010.2720] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A young man with bipolar disorder was admitted in a coma. Cerebral oedema secondary to severe hyponatraemia was implicated. This was due to self-induced water intoxication. He developed rhabdomyolysis, a massive creatine kinase (out of proportion to longstanding antipsychotic medication) and acute renal failure. In the intensive care unit, hyponatraemia was corrected, and following appropriate fluid resuscitation, with forced alkaline diuresis, the rhabdomyolysis and renal function normalised, averting renal support. While a full recovery ensued, the persisting risk factors for hyponatraemia, that is polydipsia, and its association with rhabdomyolysis, increased the chances of a recurrence. Closely supervised regulation of his water intake, and monitoring of antipsychotic efficacy (for biochemical homeostatsis) are essential for secondary prevention. Rhabdomyolysis is a rare complication of hyponatraemia. When associated with psychogenic polydipsia, the acute and chronic management are challenging. Vaptans, which are aquaretics, that preferentially prevent renal tubular water reabsorption, may be beneficial in this situation.
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Affiliation(s)
- Alexia Katsarou
- Department of Medicine, Central Middlesex Hospital, London, UK
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Meulendijks D, Mannesse CK, Jansen PA, van Marum RJ, Egberts TC. Antipsychotic-Induced Hyponatraemia. Drug Saf 2010; 33:101-14. [DOI: 10.2165/11319070-000000000-00000] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Ellis C, Cuthill J, Hew-Butler T, George SM, Rosner MH. Case report: exercise-associated hyponatremia with rhabdomyolysis during endurance exercise. PHYSICIAN SPORTSMED 2009; 37:126-32. [PMID: 20048498 DOI: 10.3810/psm.2009.04.1693] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Exercise-associated hyponatremia (EAH) has been well described in the literature, and its pathogenesis has been elucidated. The most common presenting symptoms of EAH are confusion or severe alterations in mental status. Although rhabdomyolysis in association with hyponatremia has been described in other settings, only 1 case of EAH associated with rhabdomyolysis at presentation has been previously described. In this article, we report on the occurrence of EAH with rhabdomyolysis in 4 athletes participating in the West Highland Way Race, a 95-mile endurance foot race. The pathogenesis of this association is described with implications for therapy.
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Morita S, Inokuchi S, Yamamoto R, Inoue S, Tamura K, Ohama S, Nakagawa Y, Yamamoto I. Risk factors for rhabdomyolysis in self-induced water intoxication (SIWI) patients. J Emerg Med 2008; 38:293-6. [PMID: 18439783 DOI: 10.1016/j.jemermed.2007.09.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 09/13/2007] [Accepted: 09/21/2007] [Indexed: 01/26/2023]
Abstract
Self-induced water intoxication (SIWI) patients present with various neurological and non-neurological symptoms. However, it is reported that non-neurological manifestations such as rhabdomyolysis are comparatively rare. The mechanism underlying rhabdomyolysis remains controversial. To investigate this further, we evaluated 22 SIWI patients for rhabdomyolysis. We reviewed the records of 22 patients with SIWI and evaluated their clinical characteristics. These patients were divided into the following two groups: Group A with rhabdomyolysis and Group B without it. We compared these groups to study the risk factors underlying the occurrence of rhabdomyolysis. Furthermore, we compared the complications and the duration of hospitalization between the two groups. The maximum serum sodium correction speed per hour, the increase in the serum sodium level in the initial 24 h, and the duration of hospitalization for group A were faster, higher, and longer, respectively, when compared with those in group B. Only group A patients showed complications. The rapid correction of hyponatremia may possibly trigger rhabdomyolysis in SIWI patients.
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Affiliation(s)
- Seiji Morita
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Kanagawa, Japan
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Elevated serum creatine kinase levels in psychiatric practice: differential diagnosis and clinical significance: A brief, practical guideline for clinicians. Int J Psychiatry Clin Pract 2008; 12:147-50. [PMID: 24916627 DOI: 10.1080/13651500701784930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction. Elevated serum CK levels often occur in psychiatric in-patient practice. Although the majority of cases are benign and temporary, it is important to recognize and treat these conditions. Aims. To discuss the etiology, the clinical significance and the management of elevated creatine kinase levels in psychiatric in-patient practice, focusing on antipsychotic-induced rhabdomyolysis. To compare the pathogenesis and the clinical features of rhabdomyolysis and neuroleptic malignant syndrome. Methods. Review of the literature. Results. A brief, practical guideline is introduced, which may help clinicians in the differential diagnosis and in the management of patients with elevated creatine kinase activity in emergent psychiatric practice. Conclusions. The most common etiologic factors (prescription drugs, alcohol, physical reasons, cardiac etiology) and clinical syndromes (rhabdomyolysis, neuroleptic malignant syndrome, acute coronary syndrome) should be considered, when elevated creatine kinase levels are encountered in psychiatric in-patients. Routine creatine kinase measurements in asymptomatic patients on antipsychotic medications are not recommended, but patients should be carefully followed for the development of rhabdomyolysis, when muscular symptoms arise. Careful monitoring of symptoms and potential complications is critical in order to avoid devastating clinical consequences. Cautiously challenging patients with another antipsychotic after an antipsychotic-induced rhabdomyolysis is recommended to decrease the possibility of recurrence.
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Strachan P, Prisco D, Multz AS. Recurrent rhabdomyolysis associated with polydipsia-induced hyponatremia - a case report and review of the literature. Gen Hosp Psychiatry 2007; 29:172-4. [PMID: 17336668 DOI: 10.1016/j.genhosppsych.2006.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 12/03/2006] [Accepted: 12/04/2006] [Indexed: 12/23/2022]
Abstract
Rhabdomyolysis involves the breakdown of muscle due to an inciting insult. It has been reported to have many etiologies. Some of the more common causes are trauma and medications. Therapy involves vigorous hydration with a crystalloid or bicarbonate infusion and aims to prevent renal failure caused by the release of myoglobin. This case report describes a patient with a recurrent episode of rhabdomyolysis associated with self-induced water intoxication. He was initially treated with a 3.0% saline infusion, followed by a sodium bicarbonate infusion, with correction of his electrolytes and resolution of the rhabdomyolysis.
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Affiliation(s)
- Paul Strachan
- Division of Pulmonary and Critical Care, Stony Brook Medical Center, State University of New York at Stony Brook, Stony Brook, NY 11794, USA.
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Akkaya C, Sarandol A, Sivrioglu EY, Kotan Z, Kirli S. A patient using ziprasidone with polydipsia, seizure, hyponatremia and rhabdomyolysis. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30:1535-1538. [PMID: 16820256 DOI: 10.1016/j.pnpbp.2006.05.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 05/28/2006] [Accepted: 05/29/2006] [Indexed: 11/25/2022]
Abstract
We aimed to report a case with rhabdomyolysis related to hyponatremia and/or its correction. A 32-year-old male schizophrenic patient on ziprasidone treatment was admitted to the hospital following a seizure. Patient had primary polydipsia and secondarily developed hyponatremia. After the correction of hyponatremia, due to the high liver enzyme levels, he was diagnosed as rhabdomyolysis. Although the role of antipsychotics in this situation is speculative, development of rhabdomyolysis related to hyponatremia and/or its correction should not be underestimated and should be assessed thoroughly.
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Affiliation(s)
- Cengiz Akkaya
- Department of Psychiatry, Uludag University Faculty of Medicine, Bursa, Turkey.
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John Wiley & Sons, Ltd.. Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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