Four patients with end-stage renal failure on intermittent hemodialysi
s in whom rhabdomyolysis developed after major surgery are described.
This possibly underdiagnosed complication was manifested by extreme hy
perphosphatemia, hypocalcemia, and elevated creatine phosphokinase lev
els. Serum myoglobin levels further supported the diagnosis. The metab
olic abnormalities reached a peak on the fourth postoperative day. The
possible precipitating factors included opiates used for anesthesia a
nd postoperative pain central, anesthetic agents, and surgical positio
n. The preferred treatment option is increasing dialysis to control hy
perphosphatemia and hypocalcemia. (C) 1998 by the National Kidney Foun
dation, Inc.