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논문분류	춘계학술대회 초록집
제목	Rhabdomyolysis induced by hypocalcemia
저자	Yoo Hyung Kim1, Young Rok Ham* 1, Dae Eun Choi1, Kang Wook Lee1, Ki Ryang Na1
출판정보	2016; 2016(1):
키워드	Hypocalcemia, Rhabdomyolysis
초록	Background: Rhabdomyolysis is a breakdown of skeletal muscle, which manifestates from subclinical laboratory abnormality to life-threatening condition. The causes of rhabdomyolysis is variable; exercise, trauma, drug and electrolyte imbalance, etc. Calcium is important electrolyte which is stored mostly in bone. Methods: Parathyroid hormone and vitamin D regulate the level of calcium in serum via the regulation of intestine, kidney and bone, because calcium can affect cardiac autonomy, contractility, muscle contraction and extraosseous calcification. In the case of rhabdomyolysis, hypocalcemia could be the result of rhabdomyolysis and the cause of rhabdomyolysis, which is rare. Here, we introduced hypocalcemia as the cause of rhabdomyolysis. Results: Fifty three year-old male without other drug history came to our hospital. His mother was mentally retarded and patient was diagnosed moderate mental retardation 15 years ago, although his 1 brother and 3 sisters are not mentally retarded. One month before admission, he felt left arm pain and could not extend left elbow. His both arms were weakened 1 week ago and he could not extend his fingers 3 days ago. Laboratory result which was done in 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) and thyroid function test were in normal range. Three days later, he was admitted to our hospital. Initial laboratory result showed calcium 5.8 mg/dL, phosphorus 2.1 mg/dL, magnesium 1.22 mg/dL, total vitamin D 22.47 ng/dL and parathyroid hormone 134.76 pg/mL. In addition, creatinine phosphokinase was more than 15,000 U/L and AST, ALT and LDH were 353, 88, 3748 U/L, respectively. Because he had no history of trauma, exercise and drug and antibodies to rule out autoimmune disease were all negative, rhabdomyolysis induced by hypocalcemia was assumed. After 2 days of calcium gluconate intravenous infusion, his numbness was improved, thereafter serum calcium increased. For 10 days of calcium infusion and hydration, his symptom and laboratory result were improved. He was discharged with alfacalcidol 0.5 mcg once a day and calcium carbonate 500mg three times a day. Although he was prescribed with alfacalcidol for six months, his total vitamin D level was still under 3 ng/dL. Conclusion: Hypocalcemia under 6 mg/dL is rarely occurred and hypocalcemia induced rhabdomyolysis is also a rare condition. Moreover, hypocalcemia can be induced by rhabdomyolysis and most of guidelines of rhabdomyolysis recommend that calcium should not be administered even serum calcium is low; because calcium can be released after improvement of rhabdomyolysis from muscles. With this rare case, we recommend that measuring vitamin D and parathyroid hormone could help physician to distinguish low serum calcium as a result or a cause of rhabomyolysis and decide therapeutic options.
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