Rhabdomyolysis Due to Severe Hypophosphatemia in Diabetic Ketoacidosis

Rhabdomyolysis(RM) is a syndrome characterized by injury to skeletal muscle fibers with disruption and release of toxic metabolites into circulation. It is characterized by triad of muscle weakness, myalgia and dark urine and is associated with increased creatine kinase (CK) and lactate dehydrogenase (LDH). A severely malnourished 10 year old girl with severe diabetic ketoacidosis (DKA) as hemr initial presentation of type 1 diabetes mellitus developed rhabdomyolysis (CK- 12,000 U/L) with nonoliguric renal failure during her initial course of hospital stay. The possible cause of her RM was attributed to severe hypophosphatemia (minimum serum phosphate, 0.8 mg/dL). Management of DKA, phosphate supplementation and urinary alkalinization with diuresis improved her clinical course. She was discharged on Day 9 with Insulin. We recommend frequent monitoring of serum phosphate during early period of DKA, particularly in malnourished children, and its normalization in case of severe hypophosphatemia. 
 Keywords: diabetic ketoacidosis; hypophosphatemia; malnutrition; renal failure; rhabdomyolysis