Journal of the Chinese Medical Association
Volume 72, Issue 10 , Pages 555-558, October 2009

Extreme Hypernatremia Combined With Rhabdomyolysis and Acute Renal Failure

  • Tzu-Ying Yang

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Jei-Wen Chang

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Min-Hua Tseng

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Hsin-Hui Wang

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Dau-Ming Niu

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Ling-Yu Yang

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Ling-Yu Yang, Department of Pediatrics, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Received 17 February 2009; accepted 25 May 2009.

Article Outline

Rhabdomyolysis is a life-threatening condition that involves muscle cell destruction. Among its etiologies, severe hyper-natremia is a less common cause. We report a teenage girl with congenital central hypoventilation syndrome and hypothalamus dysfunction syndrome who presented with extreme hypernatremia (sodium, 211 mmol/L) with rhabdomyolysis (creatine kinase, 32,850 U/L) and acute renal failure (creatinine, 6.1 mg/dL) following gastroenteritis with 7-kg weight loss. Rhabdomyolysis subsequently led to acute renal failure and hyperkalemia. Acute hemodialysis was initiated on hospital day 3 for hyperkalemia. This resulted in a 13 mmol/L fall in serum sodium in 3 hours despite using a 156 mmol/L sodium bath, but without the development of cerebral edema or neurological defect. This report highlights an unusual cause of rhabdomyolysis in children and the experience of managing such a difficult clinical situation. [J Chin Med Assoc 2009;72(10):555–558]

Key Words:  acute renal failure , congenital central hypoventilation syndrome , hypernatremia , hypothalamus dysfunction syndrome , rhabdomyolysis

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PII: S1726-4901(09)70428-9

doi:10.1016/S1726-4901(09)70428-9

Journal of the Chinese Medical Association
Volume 72, Issue 10 , Pages 555-558, October 2009

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