[A case of rhabdomyolysis with administration of intravenous vasopressin].

A 73-year-old man with alcoholic liver cirrhosis was admitted to our hospital because of massive hematemesis. He was treated with continuous intravenous infusion of vasopressin of 0.2 U/min. 22 hours after the infusion, he complained of myalgia, muscle weakness and skin mottling in the extremities. The skin lesion extended to the back. The serum CK and myoglobin levels were elevated to 52,280 IU/L and 84,400 ng/ml respectively. The urinary myoglobin level was elevated to 732,000 ng/ml. On the fifth hospital, he died of bleeding from the esophageal varices. Autopsy examination demonstrated necrosis of the skeletal muscle cells and myoglobin casts in the renal tubules. Our patient was probably hypersensitive to vasopressin because of underlying liver dysfunction. The massive myonecrosis might be induced from the following conditions; overreactive vasopressin-induced vasoconstriction resulted in ischemic muscle damage, and hypersensitive sarcoplasmic reticulum released excessive Ca2+ followed by muscle hypercontraction as seen in malignant syndrome or malignant hyperthermia.