Acute rhabdomyolysis complicating status asthmaticus in children: case series and review.

Abstract:

OBJECTIVES:To describe a case series of 4 children who developed acute rhabdomyolysis as a complication of acute respiratory failure secondary to status asthmaticus. METHODS:A retrospective review of all children who were admitted to our pediatric intensive care unit (PICU) with status asthmaticus from November 1998 through July 2004 was performed and all children who developed acute rhabdomyolysis, defined as a 5-fold increase above the upper limit of normal in the serum creatine phosphokinase (CPK) concentration (CPK > or = 1250 IU/L), were identified. Demographic and clinical data were abstracted from the medical record. RESULTS:During the study period, 108 children with status asthmaticus were admitted to our PICU (3.6% of all admissions). Four children (age 12-19 years) developed acute respiratory failure requiring mechanical ventilation, and all 4 of these children (3.7% of all children with status asthmaticus admitted to the PICU) developed acute rhabdomyolysis. The 4 children who developed acute rhabdomyolysis were older than the children with status asthmaticus, without rhabdomyolysis (median age 15 years vs. 5 years). CONCLUSIONS:Acute rhabdomyolysis complicating status asthmaticus may be more common than previously ascertained. We therefore suggest that CPK levels should be followed closely in all children with status asthmaticus and acute respiratory failure. The early presentation of rhabdomyolysis in the current series suggests that factors other than corticosteroids and neuromuscular blockers are potentially involved. Mechanical ventilation and older age seem to be significant risk factors for rhabdomyolysis, perhaps implicating a mechanism similar to the pathogenesis of severe exercise-related rhabdomyolysis. Further clinical study of the incidence and causative factors of rhabdomyolysis in this population is warranted.

journal_name

Pediatr Emerg Care

journal_title

Pediatric emergency care

authors

Mehta R,Fisher LE Jr,Segeleon JE,Pearson-Shaver AL,Wheeler DS

doi

10.1097/01.pec.0000230711.81646.7a

subject

Has Abstract

pub_date

2006-08-01 00:00:00

pages

587-91

issue

8

eissn

0749-5161

issn

1535-1815

pii

00006565-200608000-00012

journal_volume

22

pub_type

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