Successful Treatment of Hypercalcemia During Continuous Renal Replacement Therapy in Patient with Rhabdomyolysis Following Cardioversion and Cardiopulmonary Resuscitation

Korean Journal of Nephrology 2009;28(5):508-513.

Jee Min Park, M.D.1., Gyu Rak Chon, M.D.2., Jun Ho Wang, M.D.2. Tae Ui Lee, M.D.3. and Woo Sung Lee, M.D.4

Department of Pediatrics¹
Ajou University School of Medicine, Suwon, Korea, Department of Internal Medicine²
Department of General Surgery³
Department of Thoracic Surgery⁴
Konkuk University School of Medicine, Chungju, Korea

증례 : 심폐소생술과 제세동 후에 발생한 횡문근융해증 환자에서 지속적 신대체요법 중 발생한 고칼슘혈증의 성공적인 치료

박지민1, 전규락2, 왕준호2, 이태의3, 이우성4

아주대학교 의과대학 소아과학교실1, 건국대학교 의과대학 내과학교실2, 건국대학교 의과대학 외과학교실3, 건국대학교 의과대학 흉부외과학교실4

Abstract

Rhabdomyolysis is a common clinical and laboratory syndrome resulting from reversible skeletal muscle injury, with release of muscle cell contents into the plasma. Cardioversion, and cardiopulmonary resuscitation may produce rhabdomyolysis and myoglobinuria. We report a 5-year-old boy surviving after cardiopulmonary resuscitation and repeated 5 times of cardioversion. He showed elevated serum BUN and creatinine levels, requiring hemodialysis treatment. We had tried 5 times of intermittent hemodialysis, but oliguria was continued and there was no change of serum BUN and creatinine. His urine output was less than 100 cc per day and he showed severe edema and weight gain of 7 kg, and so we started the continuous renal replacement therapy (PrismaflexⓇ, gambro). After 12 days of continuous venovenous hemodiafiltration (CVVHDF), his urine output recovered and his BUN, creatinine, liver enzyme, creatine kinase, and lactate dehydrogenase levels returned to normal. During the treatment of CVVHDF, he had shown persistent hypercalcemia, and so we changed dialysate and replacement solution from hemosol B0 to calcium free solution. The hypercalcemia was controlled successfully using this calcium free pharmacy-made bicarbonate solution.

Key Words: Rhabdomyolysis, Cardiopulmonary resuscitation, Cardioversion, Hemodiafiltration, Hypercalcemia