Nontraumatic rhabdomyolysis in hyperosmolar nonketotic diabetic coma: A case report

G. Famularo, M. Perino, S. Polchi, M. Giacanelli, A. Taddeo, A. Nobili, C. Paolini, A. Panegrossi

Research output: Contribution to journalArticlepeer-review


Rhabdomyolysis greatly increases the risk of death in subjects with diabetic emergencies but only a few cases have been so far reported. We describe a patient with hyperosmolar nonketotic diabetic coma whose course was complicated by rhabdomyolysis progressing to acute renal failure. The course was severe but renal function was recovered to normal. Major determinants for the occurrence of rhabdomyolysis in diabetic subjects are hyperosmolarity and elevated blood levels of sodium and glucose. Hyperosmolar nonketotic diabetic coma is strongly predictive for acute renal failure and risk of death in subjects admitted because of diabetic emergencies; advanced age, previous dehydration and hyperuricemia are additional predictive factors. Clinical expression of rhabdomyolysis is small in diabetic patients as they rarely experience muscle discomfort and so the finding of elevated serum concentrations of creatinkinase (> 1000 IU/l) in the absence of acute myocardial infarction, stroke and end-stage renal disease is crucial to the early diagnosis of rhabdomyolysis. Even though no specific treatment for rhabdomyolysis is available, prompt resuscitation with fluid load has the potential to prevent the development of acute renal failure. Other strategies with claimed benefit, such as dantrolene, intravenous mannitol and urine alkalinization by administration of sodium bicarbonate, require further investigation.

Original languageEnglish
Pages (from-to)113-116
Number of pages4
JournalEuropean Journal of Internal Medicine
Issue number2
Publication statusPublished - 1998


  • Hyperosmolar nonketotic diabetic coma
  • Myoglobinuria
  • Rhabdomyolysis

ASJC Scopus subject areas

  • Medicine(all)
  • Internal Medicine


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