Emotionally-intense situations can result in rhabdomyolysis in McArdle disease.

Despite the majority of patients with McArdle disease reporting symptoms including fatigue, cramps and episodes of myoglobinuria from early childhood, diagnosis is often delayed by several decades. Additionally, many individuals with rhabdomyolysis remain undiagnosed. The occurrence of symptoms during exercise, particularly isometric muscle contraction such as heavy lifting, is well known in McArdle disease. However, isometric muscle contraction that occurs with emotion is not recognised as exercise and may be missed as a trigger for rhabdomyolysis, potentially leading to a delay in diagnosis. Three patients are presented here, all with symptoms from childhood including episodes of rhabdomyolysis induced by tense emotional situations without physical exertion; two patients reported recurrent episodes while watching rather than playing football. The remaining patient developed rhabdomyolysis during a heated argument. These patients' histories emphasise the risk from sustained isometric muscle contraction that occurs in emotive situations for patients with McArdle disease.

Clinical predictors of psychiatric and medical morbidities of charcoal-burning suicide attempt in Hong Kong.

OBJECTIVE: This naturalistic retrospective cohort study explored the demographic and clinical factors associated with psychiatric and medical morbidities among patients with suicide attempts by burning charcoal. METHOD: We conducted a follow-up study of 69 cases with charcoal-burning suicide attempts in two general hospitals. The associations between demographic, clinical characteristics and outcomes were analyzed. RESULTS: The presence of past psychiatric treatment, past history of suicide attempt and physical complications were associated with the occurrence of psychiatric morbidity after the index suicide attempt. Loss of consciousness and abnormal blood acidity were associated with medical morbidity after the index admission. CONCLUSION: Psychiatric and medical morbidities are common among charcoal-burning suicide attempts and identified clinical factors associated with these problems may be useful in its management.

Myoglobinuria caused by exertional rhabdomyolysis misdiagnosed as psychiatric illness.

BACKGROUND: Rhabdomyolysis is severe and acute skeletal muscle damage resulting in sarcolemma disruption. During injury, intracellular muscle contents are released into the plasma. The consequences may cause hypovolemia, electrolyte abnormalities, compartment syndrome, or even acute renal failure and dialysis. CASE REPORT: We present the history of a patient in whom exertional rhabdomyolysis was misdiagnosed. A 20-year-old male police recruit was admitted to a psychiatric hospital because of complaints about black urine and severe thigh pain. Serum creatinine kinase (CK) was significantly elevated at 87,335 U/l. Urinalysis showed brown color and cloudiness. Serum myoglobin was also significantly increased. Aspartate aminotransferase was elevated as was alanine aminotransferase. Immediate intravascular fluid hydration and hospital rest under renal, metabolic, and hematological monitoring was performed. CONCLUSIONS: Gymnastic teachers and people at environmental risk of rhabdomyolysis, such as members of the armed forces, police, and supervisors of physical laborers, need to remember the risks of intensive and repetitive exercise. Symptoms such as dark urine, myalgia, and muscle weakness should immediately arouse suspicion of rhabdomyolysis. Especially dark-colored urine should always be investigated for the occurrence of rhabdomyolysis.

Renal failure associated with laxative abuse.

Eating disorder patients often abuse laxatives in an attempt to purge excess food. Laxative abuse can cause hypokalemia and volume depletion. Hypokalemia, in turn, can lead to rhabdomyolysis. Laxative-induced hypokalemia and volume depletion have been previously reported to cause renal insufficiency, but not severe enough to require hemodialysis. A 27-year-old woman with a long history of laxative abuse presented with severe renal failure associated with hypokalemia and volume depletion. She required acute hemodialysis for worsening acidosis (pH 7.05) despite assisted ventilation. A prior episode of hypokalemic rhabdomyolysis at age 23 had resulted in only mild renal insufficiency. Her later episode of severe renal failure was linked to profound volume depletion (blood urea nitrogen 135 mg/dl). This patient calls attention to a potentially life-threatening complication of laxative abuse and indicates that volume depletion can exacerbate laxative-associated renal failure.

Water intoxication in a schizophrenic patient with rhabdomyolysis.

We report a case of water intoxication in a 54-year-old female schizophrenic patient with rhabdomyolysis. She had been admitted to a mental hospital, and treated with spiperone 6 mg daily. On August 3, 1992, the coma following a convulsion occurred. Laboratory data initially showed marked hyponatremia and hypochloremia with decreased serum potassium, and a gradual increase in serum creatine phosphokinase (CPK). The elevation in serum CPK with marked hyponatremia observed in the present patient was probably caused by excessive drinking of water. In this patient, the CPK elevation revealed the rhabdomyolysis.