Rhabdomyolysis; is it an overlooked DKA complication

Background: Rhabdomyolysis is considered by some studies as a rare complication of a common disorder of diabetic ketoacidosis, while others consider it as not so uncommon. The mechanism is still not clear but can be attributed to a number of factors like acidosis, hyperglycemia and electrolyte disturbances especially hypophosphatemia and hypokalaemia. Missing it may lead to more serious complications and may prolong and/or complicate full recovery of diabetic ketoacidosis. Aim: The aim of this study was to measure the incidence of rhabdomyolysis among patients presented with diabetic ketoacidosis in the emergency department of Baghdad Teaching hospital, its relation to the severity of diabetic ketoacidosis and the associated electrolytes disturbances. Patients and methods: This is a cross sectional study carried out in the emergency department of Baghdad teaching hospital/Iraq; where 43 patients with type1 diabetes presenting with diabetic ketoacidosis were included. Diabetic ketoacidosis was classified into mild, moderate and severe, and the incidence of rhabdomyolysis was calculated accordingly. Full blood investigations, urinary ketones and arterial blood gasses were done. Results: Rhabdomyolysis was found in 3 (6.98%) patients with more severe acidosis and urinary ketones in the setting of moderate and severe diabetic ketoacidosis. Statistically significant finding was observed with the duration of diabetes, higher serum creatinine, higher serum potassium, higher serum chloride, severe acidosis and urinary ketones. Conclusions: Rhabdomyolysis incidence in this study was 6.98% of patients with more severe acidosis, urinary ketones in the setting of moderate to severe diabetic ketoacidosis and with longer duration of diabetes. (C) 2018 Diabetes India. Published by Elsevier Ltd. All rights reserved.