Rhabdomyolysis as an Unusual Complication of Hyperosmolar Hyperglycemic State

Objectives: Hyperosmolar hyperglycemic state (HHS) is one of the serious metabolic derangements that occurs in patients with diabetes mellitus, Cases associated with hyperosmolarity due to diabetic ketoacidosis or hyperosmolar hyperglycemic state have also been described, and hypophosphatemia may contribute to the risk of rhabdomyolysis in some of these patients, Rhabdomyolysis is a potentially life-threatening syndrome characterized by muscle necrosis and the release of intracellular muscle contents into the circulation, associated acute kidney injury (AKI) and severe electrolyte derangements are life-threatening, and are accompanied by extreme elevations in CK levels.
Case Report: A 47 year-old Egyptian gentleman, admitted to our center ICU with obtundation and dehydration with a 4-day history of generalized weakness, nausea and persistent vomiting. The patient had strong family history of type 2 diabetes mellitus. On admission, Neurological evaluation was irrelevant. Radiological evaluations revealed left basal pneumonic
patch. His relatives deny any history of drug or alcohol abuse. Laboratory evaluation fulfilled the proposed diagnostic criteria for acute kidney injury, rhabdomyolysis and Hyperosmolar hyperglycemic state.
Conclusion: Type 2 diabetes mellitus may be presented for the first time by serious complication as HHS which in turn can cause a sever morbidities like rhabdomyolysis and acute kidney injury.