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Kim, Baek, Lee, Hahm, Jung, Kim, Kim, Kim, Chung, and Jung: Clinical Characteristics of Patients with Hyperglycemic Emergency State Accompanying Rhabdomyolysis
Original Article
Endocrinology and Metabolism

Endocrinology and Metabolism 2011; 26(4): 317-323.

Published online: 21 December 2011

DOI: https://doi.org/10.3803/EnM.2011.26.4.317

Clinical Characteristics of Patients with Hyperglycemic Emergency State Accompanying Rhabdomyolysis

Soo Kyoung Kim1, Jong Ha Baek1, Kyeong Ju Lee1, Jong Ryeal Hahm1, 2, Jung Hwa Jung1, 2, Hee Jin Kim1, Ho-Su Kim1, Sungsu Kim1, Soon Il Chung1, 2, Tae Sik Jung1, 2

1Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.

2Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.

Corresponding author: Tae Sik Jung. Department of Internal Medicine, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 660-702, Korea. Tel: +82-55-750-8470, Fax: +82-55-758-9122, taesikjung@gmail.com

Received 18 March 2011       Accepted 13 October 2011

Copyright © 2011 Korean Endocrine Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The purpose of this study was to investigate the prevalence of rhabdomyolysis and its association with both clinical course and prognosis and to evaluate the factors associated with rhabdomyolysis in patients with hyperglycemic emergencies.

Methods

We reviewed the medical records of patients with hyperglycemic emergencies who visited our hospital from May 2003 to April 2010. We assessed the clinical characteristics, biochemical profiles and clinical course of patients and analyzed these data according to the presence of rhabdomyolysis.

Results

The prevalence of rhabdomyolysis was 29 patients (28.4%) among 102 patients. Mean serum osmolarity, glucose and serum creatinine levels were higher in patients with rhabdomyolysis than those without rhabdomyolysis. Patients with rhabdomyolysis had higher rates of hemodialysis and mortality than those without the condition. The factors associated with rhabdomyolysis in the hyperglycemic emergency state were increased serum osmolarity and APACHE II score on admission (P < 0.05).

Conclusion

Rhabdomyolysis commonly occurred in patients with hyperglycemic emergencies and this could aggravate their clinical course and increase mortality.

Keywords: Diabetic ketoacidosis, Hyperglycemic hyperosmolar syndrome, Rhabdomyolysis

Figures and Tables

Fig. 1
Receiver operating characteristic curves for the prediction of the occurrence of rhabdomyolysis in hyperglycemic emergency state. A. Acute physiology and chronic health evaluation (APACHE) II score. B. Serum osmolality.
enm-26-317-g001
Table 1
Comparison of clinical characteristics and laboratory findings between DKA, DKA & HHS, and HHS groups
enm-26-317-i001

Values are presented as mean ± SD or median (minimum - maximum).

APACHE, acute physiology and chronic health evaluation; BUN, blood urea nitrogen; CK, creatinine kinase; DKA, diabetic ketoacidosis; HHS, hyperglycemic hyperosmolar state; ICU, intensive care unit; LDH, lactate dehydrogenase.

Table 2
Clinical characteristics of patients with and without rhabdomyolysis in hyperglycemic emergency
enm-26-317-i002

Values are presented as means ± SD or median (minimum - maximum).

APACHE, acute physiology and chronic health evaluation; BUN, blood urea nitrogen; CK, creatinine kinase; ICU, intensive care unit; LDH, lactate dehydrogenase.

Table 3
Precipitating factors of hyperglycemic emergency
enm-26-317-i003

Values are presented as number (%).

Table 4
Multiple logistic regression analysis for the occurrence of rhabdomyolysis in hyperglycemic emergency
enm-26-317-i004

Logistic regression was applied to estimate OR with 95% CI for occurrence of rhabdomyolysis. Each OR was adjusted for all other variables in the table.

APACHE, acute physiology and chronic health evaluation; BUN, blood urea nitrogen; CI, confidence interval; OR, odds ratio.

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