J Korean Soc Pediatr Nephrol.  2013 Oct;17(2):132-136.

Continuous Renal Replacement Therapy in a 4-year-old Child with Rhabdomyolysis Following Parainfluenza Virus Infection and Hyperammonemia due to Isovaleric Acidemia

• Park SJ
• Cho SY
• Pai KS
• Shin JI

Abstract

Parainfluenza virus infection is one of the causes of fatal rhabdomyolysis. Rhabdomyolysis can be aggravated by mitochondrial fatty acid beta-oxidation disorders during prolonged periods of fasting. Moreover, in patients with late-onset isovaleric acidemia, hyperammonemia may occur following catabolic stress. In the present report, we describe a case of a 4-year-old boy with parainfluenza virus infection and late-onset isovaleric acidemia that rapidly progressed to coma, seizures, and cardiorespiratory collapse. His serum ammonia and creatinine kinase (CK) levels were 385 microMol/L and 23,707 IU/L, respectively. Continuous renal replacement therapy (CRRT) was initiated using continuous venovenous hemodiafiltration, after which the ammonia and CK levels returned to normal. Thus, we recommend the immediate initiation of CRRT in the management of patients with life-threatening rhabdomyolysis and hyperammonemia.

Keyword

Rhabdomyolysis; Hyperammonemia; Parainfluenza virus; Isovaleric acidemia; Continuous renal replacement therapy

MeSH Terms

Amino Acid Metabolism, Inborn Errors
Ammonia
Child*
Coma
Creatinine
Fasting
Hemodiafiltration
Humans
Hyperammonemia*
Isovaleryl-CoA Dehydrogenase
Male
Paramyxoviridae Infections*
Phosphotransferases
Preschool Child*
Renal Replacement Therapy*
Rhabdomyolysis*
Seizures
Ammonia
Creatinine
Isovaleryl-CoA Dehydrogenase
Phosphotransferases