Triple Electrolyte Disorder (Hypokalemia, Hypophosphatemia and Hypomagnesemia) - A Rare Cause of Rhabdomyolysis!

The spectrum of rhabdomyolysis ranges from an asymptomatic illness with mild elevation in the creatine kinase level to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure and disseminated intravascular coagulation. Acute kidney injury (AKI) occurs in 33-50% of patients with rhabdomyolysis. Muscular trauma is the most common cause of rhabdomyolysis. Less common causes include muscle enzyme deficiencies, electrolyte abnormalities, infectious causes, drugs, toxins and endocrinopathies. Weakness, myalgia and teacoloured urine are the main clinical manifestations. The most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration to prevent renal failure. During rhabdomyolysis the injured muscle leaks potassium leading to hyperkalemia. Hyperkalemia also occurs due to renal failure and hence hypokalemia as a cause of rhabdomyolysis is usually missed. We report a rare case of rhabdomyolysis due to combined hypokalemia, hypophosphatemia and hypomagnesemia, who despite high elevations of creatine kinase escaped renal injury.