A Case of Rhabdomyolysis Caused by Hyperosmolar Non-Ketotic Diabetic Coma with Prader-Willi Syndrome

Abstract

We encountered the first case of Prader-Willi syndrome with hyperosmolar non-ketotic diabetic coma complicated by rhabdomyolysis in Japan. The patient, a 21-year-old woman, was diagnosed as having type 2 diabetes mellitus in May 1986 and treated with diet therapy alone. She drank a great deal of juice without diet therapy from November 1989 onwards because of decayed teeth. She was admitted to a hospital because of diabetic coma on December 6, 1989, but failed to improve despite treatment. The next day she was transferred to our hospital. At that time she had muscle weakness, urinary tract infection and becteremia. Laboratory invesitgation revealed a plasma glucose of 736 mg/dl, osmolarity of 485 mOsm/l, pH of 7.449, serum LDH of 1682 IU/l, CPK of 981 IU/l (98% of the isozyme consisting of the MM type), myoglobin of 1376 ng/ml and Na of 188 mEq/l. A diagnosis of HNKC was made, and a half day after treatment her consciousenss became clear, 4 days after treatment her muscle weakness disappeared, and 10 days after treatment her serum levels of LDH, CPK and myoglobin declined to within the normal range. These observations indicate that the patient developed HNKC as a result of overeating and infection, and that rhabdomyolysis was complicated by hypernatremia, dehydration and insulin deficiency. © 1992, THE JAPAN DIABETES SOCIETY. All rights reserved.