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Abstract: TH-PO372

Hypokalemic Rhabdomyolysis as an Unusual Consequence of Cryptosporidium-Associated Diarrhea in an Immunocompromised Host: A Case Report

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Soco, Marc Lawrence S., Philippine General Hospital, Manila, Metro Manila, Philippines
  • Tan, Rey Jaime Murcia, Philippine General Hospital, Manila, Metro Manila, Philippines
Introduction

Hypokalemic rhabdomyolysis is rare and frequently overlooked. While most case reports associate it with renal potassium wasting, gastrointestinal losses leading to rhabdomyolysis have been sparsely reported. We report a case of an immunocompromised individual with cryptosporidium-associated diarrhea resulting to hypokalemic rhabdomyolysis.

Case Description

A 38-year-old Filipino male with a two-month history of anorexia, weight loss, and diarrhea presented to our institution with bilateral lower extremity weakness. Pertinent findings include hypotonia, decreased muscle strength in both lower extremities, and diminished deep tendon reflexes. Workup revealed a positive HIV test, serum creatinine 1.38 mg/dL (eGFR 64.40 mL/min/1.73m2), blood urea nitrogen 21.07 mg/dL, and potassium 1.4 mmol/L. The complete blood count, electrocardiogram, thyroid function tests, and other serum electrolytes were unremarkable. The calculated urine potassium-creatinine ratio of 0.9, transtubular potassium gradient of 3.1, normal anion gap metabolic acidosis, and a negative urine anion gap were all consistent with lower gastrointestinal potassium loss. Rhabdomyolysis was confirmed with positive urine myoglobin and elevated serum creatinine kinase (15,573 U/L). Upon further investigation into the diarrhea, he was diagnosed with cryptosporidiosis. He received potassium supplementation and adequate hydration and eventually started on anti-retroviral drugs with the eventual resolution of symptoms.

Discussion

Potassium release into the interstitial fluid is crucial in regulating muscle blood flow during skeletal muscle contraction. Severe hypokalemia, whether renal or extrarenal in origin, attenuates this physiologic vasodilation resulting in relative ischemia and muscle necrosis. Hypokalemia caused by lower gastrointestinal losses only occurs if the diarrhea is persistent, as observed in this patient with cryptosporidiosis, or if accompanied by significant volume loss. This case underscores the significance of excluding rhabdomyolysis in patients with profound symptomatic hypokalemia. Thorough evaluation and clinical suspicion can aid in accurate diagnosis and prompt treatment.