S-487 A case of rhabdomyolysis induced by hypocalcemia = S-487 A case of rhabdomyolysis induced by hypocalcemia

다국어 초록 (Multilingual Abstract)

Background: Rhabdomyolysis is a breakdown of skeletal muscle that manifests as symptoms ranging from a subclinical laboratory abnormality to a life-threatening condition. The causes vary and include exercise, trauma, drugs, and electrolyte imbalance. Hypocalcemia can be a result of rhabdomyolysis, or it can be a rare cause of rhabdomyolysis. We report a case of hypocalcemia as the cause of rhabdomyolysis. Case: A 53-year-old male without any drug history came to our hospital. The patient had been diagnosed with moderate mental retardation 15 years earlier. 1 month before admission, he felt left arm pain and could not extend his left elbow. Both arms had become weakened 1 week previously and he was unable to extend his fingers for the past 3 days. Laboratory results from a local clinic showed serum calcium 6.2 mg/dL, magnesium 2.2 mg/dL, and total vitamin D＜4.2 ng/dL. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH). thyroid function tests were in normal ranges. 3 days later, he was admitted to our hospital. Initial laboratory results showed calcium 5.8 mg/dL, phosphorus 2.1mg/dL, magnesium 1.22mg/dL, total vitamin D 22.47 ng/dL, and parathyroid hormone 134.76 pg/mL. Creatinine phosphokinase was more than 15,000 U/L. AST, ALT, and LDH were 353, 88, and 3748 U/L. He had no history of trauma, exercise, or drug use, and antibodies to rule out autoimmune disease were all negative. Rhabdomyolysis induced by hypocalcemia was therefore assumed. After 2 days of calcium gluconate intravenous infusion, his numbness improved. Thereafter, his serum calcium increased. After 10 days of calcium infusion and hydration, his symptoms and laboratory results were improved. Conclusions: Hypocalcemia under 6mg/dL rarely occurs and hypocalcemia-induced rhabdomyolysis is also a rare condition. Most guidelines for rhabdomyolysis recommend against administration of calcium, even if serum calcium is low, because calcium can be released from the muscles after improvement of rhabdomyolysis. We suggest that measuring vitamin D and parathyroid hormone could help physicians to distinguish whether low serum calcium is a result or a rare cause of rhabdomyolysis when deciding on therapeutic options.