Tetany and rhabdomyolysis due to surreptitious furosemide--importance of magnesium supplementation

Rhabdomyolysis in an elderly multitreated patient: multiple drug interactions after statin withdrawal

Rhabdomyolysis precipitated by multitherapy is most frequently described during statin treatment, due to impairment of statin clearance by drugs sharing cytochrome P450 biotransformation pathway. Modulation of membrane transporters for drug efflux, operated by substrates, can also affect drugs' tissue levels. We report rhabdomyolysis in an elderly patient, in multitreatment with different potentially myotoxic medications, taking place seven months after atorvastatin discontinuation. Affected by ischaemic heart disease, arterial hypertension and dementia-related behaviour disturbances, the patient was receiving angiotensin 2-receptor inhibitors, beta-blockers, vasodilators, diuretics, salycilates, allopurinol, proton pump inhibitors, antipsychotics and antidepressants. He had taken atorvastatin for 14 years, with constantly normal creatine-kinase plasma levels. Two months after addition of the antianginal drug ranolazine, creatine-kinase mildly increased and atorvastatin was withdrawn. Nonetheless, creatine-kinase progressively rose, with severe weakness and rhabdomyolysis developing seven months later. Muscle biopsy showed a necrotizing myopathy with no inflammation or autoimmune changes. After ranolazine withdrawal, creatine-kinase and myoglobin returned to normal levels and strength was restored. Several psychotropic and cardiovascular medications prescribed to the patient share either cytochrome P450 biotransformation and permeability-glycoprotein efflux transport. In the event of cardiovascular/neuropsychiatric polypharmacy in geriatric patients, the risk of muscle severe adverse effects from pharmacokinetic drug-drug interaction should be considered beyond the direct myotoxicity of statins.

Disorders of Fuel Metabolism: Medical Complications Associated with Starvation, Eating Disorders, Dietary Fads, and Supplements

Disorders of fuel metabolism as they relate to abnormal fuel intake,abnormal fuel expenditure, and dietary supplements are the focus of this article. The emergency physician should be aware of the medical complications that can occur as a result of starvation states,eating disorders, fad diets, hypermetabolic states, and ergogenic aids. Knowledge and understanding of the complications associated with these disorders will facilitate the diagnosis and management of patients who present to the emergency department with any of the disorders reviewed.

[Conn adenoma manifesting as reversible tetraparesis and rhabdomyolysis]

INTRODUCTION

Primary hyperaldosteronism is an uncommon cause of hypertension which classically features hypokaliemia, metabolic alkalosis and excessive urinary potassium excretion. Clinical manifestations of hypokalemia rarely reveal the diagnosis.

EXEGESE

We report the case of a hypertensive patient who developed quadriparesis and rhabdomyolysis induced by a severe hypokalemia. Clinical manifestations were reversible after potassium supplementation. Laboratory and radiological findings led to the diagnosis of an aldosterone-producing adenoma. Surgical treatment allowed correction of electrolyte abnormalities and improvement of hypertension.

CONCLUSION

Although primary aldosteronism is rare, it should be systematically considered when arterial hypertension is associated with hypokalemia, even if the potassium depletion is due to diuretic therapy.