CASE REPORT: PDF OnlyExtreme Hypernatremia Combined With Rhabdomyolysis and Acute Renal FailureYang, Tzu-Yinga; Chang, Jei-Wena, b; Tseng, Min-Huaa, b, c; Wang, Hsin-Huia, b; Niu, Dau-Minga, b; Yang, Ling-Yua, b, * Author Information aDepartment of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C. bInstitute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C. cDepartment of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan, R.O.C. *Correspondence to: Dr Ling-Yu Yang, Department of Pediatrics, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C. E-mail: [email protected] Received: February 17, 2009; • Accepted: May 25, 2009. Journal of the Chinese Medical Association: October 2009 - Volume 72 - Issue 10 - p 555-558 doi: 10.1016/S1726-4901(09)70428-9 Metrics Abstract Rhabdomyolysis is a life-threatening condition that involves muscle cell destruction. Among its etiologies, severe hyper-natremia is a less common cause. We report a teenage girl with congenital central hypoventilation syndrome and hypothalamus dysfunction syndrome who presented with extreme hypernatremia (sodium, 211 mmol/L) with rhabdomyolysis (creatine kinase, 32,850 U/L) and acute renal failure (creatinine, 6.1 mg/dL) following gastroenteritis with 7-kg weight loss. Rhabdomyolysis subsequently led to acute renal failure and hyperkalemia. Acute hemodialysis was initiated on hospital day 3 for hyperkalemia. This resulted in a 13 mmol/L fall in serum sodium in 3 hours despite using a 156 mmol/L sodium bath, but without the development of cerebral edema or neurological defect. This report highlights an unusual cause of rhabdomyolysis in children and the experience of managing such a difficult clinical situation. [J Chin Med Assoc 2009;72(10):555–558] © 2009 by Lippincott Williams & Wilkins, Inc.