Acute Renal Failure Due To Myoglobinuria Followed By Hyperosmolar Nonketotic Diabetic Coma (HNKC): A Case Report And Review Of The Literature

Diabetes is a clinic syndrome caused by heredity and environmental factors. Its incidence rate increases steadily together with the improvement of live level and population aging. Hyperosmolar nonketotic diabetic coma is acute seriously complication of diabetes mellitus. Myoglobinuria is formed when acute myocyte necrosis and rhabdomyolvsis happen. The etiological factors of myoglobinuria involve muscles injury, ischemia, metabolism disorder, infection, drug poisoning and so on. There are only several cases about acute renal failure due to myoglobinuria followed by hyperosmolar nonketotic diabetic coma. It is necessary to summary and analysis such cases in order to enhance the cognition of the disease, which is helpful to early diagnosis and promptly treatment.ObjectivesTo report a case and to review the literature of acute renal failure due to myoglobinuria followed by hyperosmolar nonketotic diabetic coma, including its etiological factor, clinical symptom, diagnosis, differential diagnosis, treatment and prognosis. Through the deepened cognition of suchscare cases, we can make early diagnosis and treat such disease promptly. MethodsTo describe the clinical data of a patient who suffered from acute renal failure due to myoglobinuria followed by hyperosmolar nonketotic diabetic coma, and review the literature to find out the similarity of all cases in aspect of etiological factors, clinical symptom, diagnosis treatment and prognosis.ResultsThe patient suffered from hyperosmolar nonketotic diabetic coma and myoglobinuria, which led to acute renal failure. Whose plasma zymogram, creatinine and urea nitrogen increased greatly, plasma osmotic pressure was more than 400mosm/s; electromyography noted the change from muscles injure. The patient prognosis was good after receiving little dose insulin injection, enough fluid support and remaining renal function.ConclusionsThe patient took tablets such as lithium carbonate because of mania, which may decline the sugar tolerance, hyperosmolar nonketotic diabetic coma would be developed if the patient met many other stress conditions, which might lead to rhabdomyolysis and myoglobinuria because of hyperosmolar enviroment. In the end acute renal failure was developed. Early diagnosis of acute renal failure due to myoglobinuria followed by hyperosmolar nonketotic diabetic coma is very important to relatively better prognosis.