SEVERE RHABDOMYOLYSIS WITH GOOD RECOVERY IN A PATIENT WITH HEAD-INJURY - CASE-REPORT

OBJECTIVE AND IMPORTANCE: We report a case of head injury, in which a hyperosmolar state evolved during the course of treatment, complicated by severe rhabdomyolysis and acute renal failure, which subsequently resulted in a good recovery after intensive supportive treatment. To o ur knowledge, such high levels of creatine kinase in a patient with he ad injury and rhabdomyolysis have not been reported. CLINICAL PRESENTA TION AND INTERVENTION: A 19-year-old male patient with head injury sus tained a compound fracture of the frontal region. He received a hypero smolar agent to treat brain edema and developed a hyperosmolar state a nd diabetes insipidus 1 day after the accident. There were no obvious associated injuries at physical examination. After admission to the in tensive care unit, the patient developed myoglobinuria and rhabdomyoly sis; serum creatine kinase was elevated to a peak of 650,000 IU/L. Fou r days later, acute renal failure was noted. The patient's myoglobinur ia and rhabdomyolysis gradually declined, and he eventually recovered from acute renal failure after supportive treatment and dialysis. CONC LUSION: We postulate that the hyperosmolar state of the patient was th e major cause of his severe rhabdomyolysis. Associated hypokalemia and hypophosphatemia are also predisposed to rhabdomyolysis. The most ser ious complication in rhabdomyolysis is acute renal failure, but most p atients who receive supportive treatment and can survive despite the c omplications can expect to have normal renal function restored.