Korean J Nephrol.  1997 Jun;16(2):385-390.

Acute Renal Failure in Rhabdomyolysis Associated with Furosemide Induced Hypokalemia

• Keum SM
• Park JH
• Park YB
• Shin JU
• Choi JW
• Kim IG
• Shon HS
• Chang SG
• Lee SC
• Bae JD
• Ahn KS

Abstract

Though hypokalemia often goes unrecognized as a cause of rhabdomyolysis, its causal relation for acute renal failure can be considered in cases of extreme hypokalemia when combined with rhabdomyolysis. We present the case of a 21-year-old female in whom acute renal failure was developed by myoglobinuria which was associated with furosemide induced hypokalemia. She had taken 2 grams of furosemide daily over 6 months before developing rhabdomyolysis. Initial neurologic examination revealed painful quadriplegia and laboratory findings showed markedly elevated blood CPK, LDH and AST levels with azotemia. Arterial blood gas analysis showed pH 7.439, serum Na 128mEq/L, K 1.5mEq/L, Cl 87mEq/L, HCO3- 12.6mmol/L and calculated anion gap of 29.9 which indicated that she was under the condition of mixed metabolic alkalosis and metabolic acidosis. Though intravenous infusion of potassium chloride improved muscle strength, azotemia and acidemia persisted for several days. This case suggest that large amount of furosemide, when used for a long time, can be result in the acute renal failure by rhabdomyolysis which was caused by hypokalemia.

Keyword

Furosemide; Hypokalemia; Rhabdomyolysis; Acute renal failure

MeSH Terms

Acid-Base Equilibrium
Acidosis
Acute Kidney Injury*
Alkalosis
Azotemia
Blood Gas Analysis
Female
Furosemide*
Humans
Hydrogen-Ion Concentration
Hypokalemia*
Infusions, Intravenous
Muscle Strength
Myoglobinuria
Neurologic Examination
Potassium Chloride
Quadriplegia
Rhabdomyolysis*
Young Adult
Furosemide
Potassium Chloride