Sudden unexpected death due to hypokalemic rhabdomyolysis associated with chronic alcohol abuse: An autopsy case.

Severe hypokalemia-induced rhabdomyolysis is rare but potentially fatal, particularly among chronic alcohol abusers who are predisposed to multiple electrolyte disturbances. This case report describes an early 40s male with chronic heavy alcohol consumption who presented with progressive neck stiffness and shoulder discomfort over several days, ultimately resulting in inability to stand. Laboratory findings revealed profound hypokalemia (1.4 mEq/L), hypophosphatemia, markedly elevated creatine kinase, and macrocytic hyperchromic anemia, suggesting alcohol-related organ dysfunction. Despite supportive care, the patient died suddenly 18 h after admission. Forensic autopsy revealed diffuse rhabdomyolysis involving skeletal muscle including the diaphragm, myoglobin cast nephropathy, advanced fatty liver with fibrosis, and structural cardiac abnormalities such as apical hypertrophic cardiomyopathy. The identified cause of death was a fatal arrhythmia triggered by severe hypokalemia, potentiated by underlying cardiac pathology. This case highlights the importance of early recognition and continuous cardiac monitoring in metabolic rhabdomyolysis, as well as the multifactorial pathogenesis of sudden unexpected death in chronic alcohol abusers.