Hyperosmolar non-ketotic diabetic syndrome associated with rhabdomyolysis and acute renal failure: a case report and review of literature.

A 64-year-old man was admitted to our hospital because of general fatigue and drowsiness. On admission, a physical examination disclosed dehydration and a laboratory investigation revealed the following values: plasma glucose, 1309 mg/dl; serum sodium, 160 mmol/l; potassium, 3.0 mmol/l; urea nitrogen, 65 mg/dl; creatinine, 2.73 mg/dl; and plasma osmolarity, 403 mOsm/kg. Urine ketone bodies were negative. A diagnosis of hyperosmolar non-ketotic diabetic syndrome was made, and hydration with an infusion of hypotonic saline (0.45%) and insulin therapy were immediately started. However, despite adequate rehydration and correction of blood glucose, his serum creatinine level increased to 3.1 mg/dl, while oliguria and myoglobinuria developed on the 4th hospital day, with serum creatine kinase increasing up to a maximum level of 16,749 IU/l, suggesting rhabdomyolysis. A final diagnosis of hyperosmolar non-ketotic diabetic syndrome associated with rhabdomyolysis and acute renal failure was made. His renal function gradually improved without hemodialysis, though acute renal failure due to rhabdomyolysis with hyperosmolar non-ketotic diabetic syndrome can sometimes be fatal. This rare case is presented along with a review of literature.