Acute rhabdomyolysis complicating status asthmaticus in children: Case series and review

Renuka Mehta, Lyle E Fisher, Joseph E. Segeleon, Anthony L. Pearson-Shaver, Derek S. Wheeler

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

OBJECTIVES: To describe a case series of 4 children who developed acute rhabdomyolysis as a complication of acute respiratory failure secondary to status asthmaticus. METHODS: A retrospective review of all children who were admitted to our pediatric intensive care unit (PICU) with status asthmaticus from November 1998 through July 2004 was performed and all children who developed acute rhabdomyolysis, defined as a 5-fold increase above the upper limit of normal in the serum creatine phosphokinase (CPK) concentration (CPK ≥1250 IU/L), were identified. Demographic and clinical data were abstracted from the medical record. RESULTS: During the study period, 108 children with status asthmaticus were admitted to our PICU (3.6% of all admissions). Four children (age 12-19 years) developed acute respiratory failure requiring mechanical ventilation, and all 4 of these children (3.7% of all children with status asthmaticus admitted to the PICU) developed acute rhabdomyolysis. The 4 children who developed acute rhabdomyolysis were older than the children with status asthmaticus, without rhabdomyolysis (median age 15 years vs. 5 years). CONCLUSIONS: Acute rhabdomyolysis complicating status asthmaticus may be more common than previously ascertained. We therefore suggest that CPK levels should be followed closely in all children with status asthmaticus and acute respiratory failure. The early presentation of rhabdomyolysis in the current series suggests that factors other than corticosteroids and neuromuscular blockers are potentially involved. Mechanical ventilation and older age seem to be significant risk factors for rhabdomyolysis, perhaps implicating a mechanism similar to the pathogenesis of severe exercise-related rhabdomyolysis. Further clinical study of the incidence and causative factors of rhabdomyolysis in this population is warranted.

Original languageEnglish (US)
Pages (from-to)587-591
Number of pages5
JournalPediatric Emergency Care
Volume22
Issue number8
DOIs
StatePublished - Aug 1 2006

Fingerprint

Status Asthmaticus
Rhabdomyolysis
Pediatric Intensive Care Units
Creatine Kinase
Respiratory Insufficiency
Artificial Respiration
Neuromuscular Blocking Agents
Medical Records
Adrenal Cortex Hormones
Demography

Keywords

  • CPK
  • Corticosteroids
  • Mechanical ventilation
  • Myoglobinuria
  • Rhabdomyolysis
  • Status asthmaticus

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

Cite this

Acute rhabdomyolysis complicating status asthmaticus in children : Case series and review. / Mehta, Renuka; Fisher, Lyle E; Segeleon, Joseph E.; Pearson-Shaver, Anthony L.; Wheeler, Derek S.

In: Pediatric Emergency Care, Vol. 22, No. 8, 01.08.2006, p. 587-591.

Research output: Contribution to journalReview article

Mehta, Renuka ; Fisher, Lyle E ; Segeleon, Joseph E. ; Pearson-Shaver, Anthony L. ; Wheeler, Derek S. / Acute rhabdomyolysis complicating status asthmaticus in children : Case series and review. In: Pediatric Emergency Care. 2006 ; Vol. 22, No. 8. pp. 587-591.
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abstract = "OBJECTIVES: To describe a case series of 4 children who developed acute rhabdomyolysis as a complication of acute respiratory failure secondary to status asthmaticus. METHODS: A retrospective review of all children who were admitted to our pediatric intensive care unit (PICU) with status asthmaticus from November 1998 through July 2004 was performed and all children who developed acute rhabdomyolysis, defined as a 5-fold increase above the upper limit of normal in the serum creatine phosphokinase (CPK) concentration (CPK ≥1250 IU/L), were identified. Demographic and clinical data were abstracted from the medical record. RESULTS: During the study period, 108 children with status asthmaticus were admitted to our PICU (3.6{\%} of all admissions). Four children (age 12-19 years) developed acute respiratory failure requiring mechanical ventilation, and all 4 of these children (3.7{\%} of all children with status asthmaticus admitted to the PICU) developed acute rhabdomyolysis. The 4 children who developed acute rhabdomyolysis were older than the children with status asthmaticus, without rhabdomyolysis (median age 15 years vs. 5 years). CONCLUSIONS: Acute rhabdomyolysis complicating status asthmaticus may be more common than previously ascertained. We therefore suggest that CPK levels should be followed closely in all children with status asthmaticus and acute respiratory failure. The early presentation of rhabdomyolysis in the current series suggests that factors other than corticosteroids and neuromuscular blockers are potentially involved. Mechanical ventilation and older age seem to be significant risk factors for rhabdomyolysis, perhaps implicating a mechanism similar to the pathogenesis of severe exercise-related rhabdomyolysis. Further clinical study of the incidence and causative factors of rhabdomyolysis in this population is warranted.",
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AU - Mehta, Renuka

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AU - Segeleon, Joseph E.

AU - Pearson-Shaver, Anthony L.

AU - Wheeler, Derek S.

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N2 - OBJECTIVES: To describe a case series of 4 children who developed acute rhabdomyolysis as a complication of acute respiratory failure secondary to status asthmaticus. METHODS: A retrospective review of all children who were admitted to our pediatric intensive care unit (PICU) with status asthmaticus from November 1998 through July 2004 was performed and all children who developed acute rhabdomyolysis, defined as a 5-fold increase above the upper limit of normal in the serum creatine phosphokinase (CPK) concentration (CPK ≥1250 IU/L), were identified. Demographic and clinical data were abstracted from the medical record. RESULTS: During the study period, 108 children with status asthmaticus were admitted to our PICU (3.6% of all admissions). Four children (age 12-19 years) developed acute respiratory failure requiring mechanical ventilation, and all 4 of these children (3.7% of all children with status asthmaticus admitted to the PICU) developed acute rhabdomyolysis. The 4 children who developed acute rhabdomyolysis were older than the children with status asthmaticus, without rhabdomyolysis (median age 15 years vs. 5 years). CONCLUSIONS: Acute rhabdomyolysis complicating status asthmaticus may be more common than previously ascertained. We therefore suggest that CPK levels should be followed closely in all children with status asthmaticus and acute respiratory failure. The early presentation of rhabdomyolysis in the current series suggests that factors other than corticosteroids and neuromuscular blockers are potentially involved. Mechanical ventilation and older age seem to be significant risk factors for rhabdomyolysis, perhaps implicating a mechanism similar to the pathogenesis of severe exercise-related rhabdomyolysis. Further clinical study of the incidence and causative factors of rhabdomyolysis in this population is warranted.

AB - OBJECTIVES: To describe a case series of 4 children who developed acute rhabdomyolysis as a complication of acute respiratory failure secondary to status asthmaticus. METHODS: A retrospective review of all children who were admitted to our pediatric intensive care unit (PICU) with status asthmaticus from November 1998 through July 2004 was performed and all children who developed acute rhabdomyolysis, defined as a 5-fold increase above the upper limit of normal in the serum creatine phosphokinase (CPK) concentration (CPK ≥1250 IU/L), were identified. Demographic and clinical data were abstracted from the medical record. RESULTS: During the study period, 108 children with status asthmaticus were admitted to our PICU (3.6% of all admissions). Four children (age 12-19 years) developed acute respiratory failure requiring mechanical ventilation, and all 4 of these children (3.7% of all children with status asthmaticus admitted to the PICU) developed acute rhabdomyolysis. The 4 children who developed acute rhabdomyolysis were older than the children with status asthmaticus, without rhabdomyolysis (median age 15 years vs. 5 years). CONCLUSIONS: Acute rhabdomyolysis complicating status asthmaticus may be more common than previously ascertained. We therefore suggest that CPK levels should be followed closely in all children with status asthmaticus and acute respiratory failure. The early presentation of rhabdomyolysis in the current series suggests that factors other than corticosteroids and neuromuscular blockers are potentially involved. Mechanical ventilation and older age seem to be significant risk factors for rhabdomyolysis, perhaps implicating a mechanism similar to the pathogenesis of severe exercise-related rhabdomyolysis. Further clinical study of the incidence and causative factors of rhabdomyolysis in this population is warranted.

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KW - Myoglobinuria

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KW - Status asthmaticus

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