低钾血症合并低T3综合征导致横纹肌溶解

Rhabdomyolysis caused by hypokalemia with low T3 syndrome

目的探讨低钾血症,合并低T3综合征导致横纹肌溶解的临床特点和可能的发病机制。方法报道2015年本院收入1例低钾血症合并低T3综合征的患者的病例资料特点、辅助检查、临床治疗效果并复习相关文献。结果患者存在肢体近端为主的无力,肌酶>10000U·L^(-1),肌红蛋白>900ng·mL^(-1),血钾1.5mmol·L^(-1)伴低T3综合征,给与碱化尿液、水化等治疗,患者血钾正常、肌酶正常,症状好转。结论低钾血症导致横纹肌溶解临床少见,低T3综合征可能导致肌细胞膜代谢紊乱从而加重横纹肌溶解。治疗中及时补充有效循环血量、及时碱化尿液促进肌红蛋白排出可以减少肾功能不全发生率。

Objective To investigate the hypokalemia, especially combined with low T3 syndrome causes of rhabdomyolysis clinical features and possible pathogenesis. Methods There is a patient with rhabdomyolysis caused by hypokalemia with low T3 syndrome in our hospital in 2015. The clinical characteristics and the results of the examination, clinical treatment effect, and the relevant literature were reviewed. Rseults The patient with limbs weakness with serum muscle enzymes were significantly increased, up to 〉 10000μ· L-1, and myoglobin in blood 〉 900ng· mL-1（ 23-112ng · mL-1）, hypokalemiae K1.5mmol · L-1 and low T3 syndrome. We consider it rhabdomyolysis giving alkalize urine, water treatment, The muscle enzyme serum kalemiae and limb muscle strength came back to the normal. In the course of the disease, there was no high potassium level and renal function failure, and limb muscle strength returned to normal. Conclusion Rhabdomyolysis caused by hypokalemia is rare, low T3 syndrome may lead to muscle cell membrane metabolism and aggravate rhabdomyolysis. The treatment of timely replenishment of effective circulating blood volume alkalineurine and myoglobin promote discharge to descrease renal dysfunction.