ACUTE NONTRAUMATIC RHABDOMYOLYSIS IN PEDI ATRIC-PATIENTS - ETIOLOGY AND PROGNOSIS

The purpose of this study was to determine the causes and prognosis of acute nontraumatic rhabdomyolysis in pediatric patients. Methods: Sev enty-one pediatric cases of acute nontraumatic rhabdomyolysis (CPK > 5 00 IU/l) managed in an intensive care unit between January 1, 1983 and June 30, 1989 were analyzed retrospectively. Acute renal failure was defined as a serum creatinine level above 12 mg/l. Results: There were 43 boys and 28 girls. Mean age was 33.5 months (range 1 month-15 year s; median age 11 months). At admission, seventy of rhabdomyolysis vari ed widely (CPK 505 to 21 700 IU/1). The CPK peak was delayed in some p atients. Causes were as follows: anoxia, 43.6% (near-miss syndrome, 15 .5%); severe hyperthermia, 17%; hydration disorders 15.4%; and infecti on, 11.4%. Seizures and coma were common (43.7% and 36.6% respectively ). Acute renal failure developed in 50% of cases and was delayed in 8 of 35 cases. All patients with severe hyperthermia and most (81.8%) wi th hydration disorders developed acute renal failure. Patients with ac ute renal failure did not have more severe rhabdomyolysis at admission but had higher peak CPK levels during hospitalization (p < 0.01). Out come was as follows: death, 43.7%; recovery with residual neurological impairment, 29.5%; and full recovery, 26.8%. Mortality rate varied ac ross causes, from 61.2% in anoxia and 58.3% in severe hyperthermia (wi th no full recoveries) to 18.2% in hydration disorders. Patients with fatal disease were more likely to have acute renal failure and had mor e severe electrolyte disorders at admission and higher peak CPK level; in contrast CPK at admission was similar in fatal and nonfatal case. Conclusion. This study demonstrated that causes of acute nontraumatic rhabdomyolysis in children are different from those encountered in adu lts, with the main cause being anoxia. Prognosis was dependent mainly on the cause, severity of rhabdomyolysis, and existence of acute renal failure. In most instances, rhabdomyolysis developed in the context o f multiple organ failure.