ACUTE MYOGLOBINURIC RENAL-FAILURE AS A RE SULT OF AUTOAGGRESSIVE BEHAVIOR ASSOCIATED WITH MENTAL-RETARDATION

A 49-year old female with mental retardation was admitted with suspect ed renal insufficiency with a raised creatinine (5.1 mg/dl), hyperkala emia (5.6 mmol/l), and a 12-hour history of diffuse abdominal pain and persistent vomiting. On admission, she had a haematoma around the rig ht shoulder and armpit, swelling of the right upperarm, and severe lim itation of movement of the right hand. These injuries were the result of trauma some 5 days previously. She was a long-term inpatient in a p sychiatric clinic, with a history of autoaggressive behaviour, which h ad led to several fractures in the past as a result of falls. The crea tinine kinase was elevated to 6680 U/l. The suspected diagnosis of acu te oliguric renal failure due to rhabdomyolysis was confirmed by the p resence of marked myoglobinuria (409 ng/ml). Because of the delay in d iagnosis, acute renal failure developed, and the patient required haem odialysis for 20 days. Because of their many predisposing factors, psy chiatric patients represent a special risk group for development of rh abdomyolysis, recognition of which is often delayed.