Furosemide-Induced Severe Hypokalemia With Rhabdomyolysis Without Cardiac Arrest

Wolfgang Ruisz; Claudia Stöllberger; Josef Finsterer; Franz Weidinger


BMC Womens Health. 2013;13(30) 

In This Article

Case Presentation

A 22-years-old female nurse was admitted because of myalgias since 10 days, vomiting and diarrhea since 4 days, and generalized weakness and dizziness since 3 days. She had a history of Raynaud's disease and of a restless leg syndrome since 9 years. She reported to take no medication against these disorders. The family history was negative for renal and muscle disease. Clinical examination showed an alert young female with 160 cm length and 46 kg weight (Body mass index 18). Blood pressure was 115/80 mm Hg and the respiratory rate 12/min. No abnormalities were found at clinical examination. There were no abnormalities in the skin turgor. Blood tests revealed severe hypokalemia with a lowest value of 1.1 mmol/l, moderate hyponatremia, metabolic alkalosis, mild renal insufficiency and creatinphosphokinase (CK) elevation (Table 1). Urine electrolytes on day 2 showed a decreased excretion of potassium (9 mmol/l, normal range 20–80 mmol/l) and sodium (29 mmol/l, normal range 54–150 mmol/l). Thyroid function tests were normal. The electrocardiogram showed ST-segment abnormalities and a prolonged QT interval (Figure 1). Since the severe hypokalemia and alkalosis were not explained by the gastrointestinal problems, she was asked for intake of diuretics even 12 hours after admission. She confessed that she has taken 250 mg furosemide/day for the last 4 months in order to improve the shape of her muscles and to have a more brawny appearance. She had received the tablets from a physician who attended the same gym where she exercised. The patient was diagnosed as suffering from furosemide-induced hypokalemia and rhabdomyolysis. Parenteral and enteral substitution of potassium, sodium and magnesium was started. The serum electrolyte levels normalized within 4 days. CK levels gradually decreased, normalized after two weeks and the myalgias regressed. A psychiatric investigation excluded suicidality, depression or eating disorder, diagnosed an adjustment disorder and recommended psychotherapy. Her heart rhythm was monitored during 7 days and did not show any arrhythmias. Echocardiography did not disclose any cardiac abnormalities, and the electrocardiogram normalized (Figure 1). After 7 days she left the hospital and returned for blood tests after one week.

Figure 1.

Electrocardiographic recordings on day 1 (A), day 3 (B) and day 7 (C) showing ST abnormalities and QT prolongation on days 1 and 3 which normalized on day 7. The QTc according to Bazett's formula was 670 msec (day 1), 405 msec (day 3) and 401 msec (day 7).