CASE REPORT   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2018 April;177(4):169-72

DOI: 10.23736/S0393-3660.17.03527-6

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Rhabdomyolysis in a patient with chronic uncontrolled diabetes mellitus and hypothyroidism

Gordana CAVRIĆ ¹ ✉, Ingrid PRKAČIN ¹, Sonja PERKOV ², Khaled NASSABAIN ³, Maja VUČKOVIĆ ¹, Dubravka BARTOLEK HAMP ⁴

¹ Department of Internal Medicine, University Hospital Merkur, Zagreb, Croatia; ² Department of Medical Biochemistry and Laboratory Medicine, University Hospital Merkur, Zagreb, Croatia; ³ Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de la Lauter, Wissembourg, France; ⁴ Department of Anesthesiology, Resuscitation and Intensive Care, Dubrovnik General Hospital, Dubrovnik, Croatia

Rhabdomyolysis is a syndrome characterised by muscle necrosis and dispersing its intracellular content in the circulation. Clinical symptoms are usually presented by muscle pain and muscle weakness. Rhabdomyolysis could be produced, among other causes, by diabetic ketoacidosis and hypothyroidism. We report a case of a 36 years old female patient who was admitted to the medical intensive care unit (MICU) because of rhabdomyolysis. At her admission we found compensated diabetic ketoacidosis with normal serum osmolarity and mild hypothyroidism. The patient was treated by rehydration, urine alkalinisation, forced augmentation of diuresis, correction of blood glucose levels, and levothyroxine substitution therapy. After 17 days, she was completely recovered and discharged home. We believe that rhabdomyolysis in our patient developed as a summary of two important factors, uncontrolled diabetes mellitus and hypothyroidism. Hypothyroidism, possibly fueled by bad regulate diabetes, may amplify the symptoms. Each considered factor separately may not be cause a muscle breakdown, but their combination can lead to serious and severe clinical symptoms associated with high levels of creatine kinase (CK) enzyme.

KEY WORDS: Rhabdomyolysis - Diabetes mellitus - Hypothyroidism