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Myoglobinuria and Hypokalemia in Regional Enteritis

Myoglobinuria and Hypokalemia in Regional Enteritis Abstract The occurrence of gross myoglobinuria in man is unusual though it has been reported in a number of circumstances. Most instances have involved either muscle injury or an undefined state in which there is recurrent myoglobinuria often after exercise. In the case to be reported here, myoglobinuria occurred in a setting of metabolic abnormalities induced by regional enteritis and its treatment with cortisone. The clinical and laboratory data suggest that exercise of muscles weakened by potassium and other deficiencies was the cause of the myoglobinuria. Report of a Case A 47-year-old civil engineer was referred to the Pratt Clinic on Oct. 22, 1953, for evaluation of regional enteritis. Six years previously, he had begun to have persistent abdominal pain and aching in various joints. One year later, in 1948, at a celiotomy, 20 cm. of the terminal ileum and the ileocecal valve were found to be indurated and inflamed. The References 1. Biörck, G.: On Myoglobin and Its Occurrence in Man , Acta Med. Scand. ( (Suppl. 226) ) 133:1-216, 1949. 2. Millikan, G. A.: Muscle Hemoglobin , Physiol. Rev. 19:503-523, 1939. 3. Yuile, C. L., and Clark, W. F.: Myohemoglobinuria: A Study of the Renal Clearance of Myohemoglobin in Dogs , J. Exp. Med. 74:187-196, 1941.Crossref 4. Gilligan, D. R., and Blumgart, H. L.: March Hemoglobinuria: Studies of the Clinical Characteristics, Blood Metabolism and Mechanism; with Observations on 3 New Cases, and Review of Literature , Medicine (Balt.) 20:341-395, 1941.Crossref 5. Carlström, B.: Über die Ätiologie und Pathogenese der Kreuzlähme des Pferdes , Skand. Arch. Physiol. 61:161-224, 1931Crossref 6. 63:164-212, 1932. 7. Hed, R.: Myoglobinuria in Man with Special Reference to a Familial Form, Stockholm, Kungl. Boktryckeriet, P. A. Norstedt and Soner, 1955 ; Acta Med. Scand. ( (Suppl. 303) ) 51:1-107, 1955. 8. Bywaters, E. G. L., and Beall, D.: Crush Injuries with Impairment of Renal Function , Brit. Med. J. 1:427-432, 1941.Crossref 9. Bywaters, E. G. L.: Ischemic Muscle Necrosis: Crushing Injury, Traumatic Edema, the Crush Syndrome, Traumatic Anuria, Compression Syndrome; A Type of Injury Seen in Air Raid Casualties Following Burial Beneath Debris , J.A.M.A. 124:1103-1109, 1944.Crossref 10. Bywaters, E. G. L., and Stead, J. K.: Production of Renal Failure Following Injection of Solutions Containing Myohemoglobin , Quart. J. Exp. Physiol. 33:53-70, 1944. 11. Montagnani, C. A., and Simeone, F. A.: Observations on the Liberation and Elimination of Myohemoglobin and of Hemoglobin After Release of Muscle Ischemia , Surgery 34:169-185, 1953. 12. Berlin, R.: Haff Disease in Sweden , Acta Med. Scand. 129:560-572, 1948.Crossref 13. Spaet, T. H.; Rosenthal, M. C., and Dameshek, W.: Idiopathic Myoglobinuria in Man: Report of a Case , Blood 9:881-896, 1954. 14. Bowden, D. H.; Fraser, D.; Jackson, S. H., and Walker, N. F.: Acute Recurrent Rhabdomyolysis (Paroxysmal Myohemoglobinuria): A Report of 3 Cases and a Review of the Literature , Medicine (Balt.) 35:335-353, 1956.Crossref 15. Farmer, T. A., Jr.; Hammack, W. J., and Frommeyer, W. B., Jr.: Idiopathic Recurrent Rhabdomyolysis Associated with Myoglobinuria , New Engl. J. Med. 264:60-66, 1961.Crossref 16. Pearson, C. M.; Beck, W. S., and Blahd, W. H.: Idiopathic Paroxysmal Myoglobinuria , A.M.A. Arch. Intern. Med. 99:376-389, 1957.Crossref 17. Schmid, R., and Mahler, R.: Chronic Progressive Myopathy with Myoglobinuria: Demonstration of Glycogenolytic Defect in Muscle , J. Clin. Invest. 38:2044-2058, 1959.Crossref 18. Acheson, D., and McAlpine, D.: Muscular Dystrophy Associated with Paroxysmal Myoglobinuria and Excessive Excretion of Ketosteroids , Lancet 2:372-375, 1953.Crossref 19. Harrison, H. E.; Tompsett, R. R., and Barr, D. P.: The Serum Potassium in 2 Cases of Sprue , Proc. Soc. Exp. Biol. Med. 54:314-315, 1943.Crossref 20. Ariel, I. M.: Chloridorrhea: Syndrome Associated with Diarrhea and Potassium Deficiency , A.M.A. Arch. Surg. 68:105-116, 1954.Crossref 21. Schwartz, W. B., and Relman, A. S.: Metabolic and Renal Studies in Chronic Potassium Depletion Resulting from Overuse of Laxatives , J. Clin. Invest. 32:258-271, 1953.Crossref 22. Brown, M. R.; Currens, J. H., and Marchand, J. F.: Muscular Paralysis and Electrocardiographic Abnormalities Resulting from Potassium Loss in Chronic Nephritis , J.A.M.A. 124:545-549, 1944.Crossref 23. Holler, J.: Potassium Deficiency Occurring During Treatment of Diabetic Acidosis , J.A.M.A. 131:1186-1189, 1946.Crossref 24. Diefenbach, W. C. L.; Fisk, S. C., and Gilson, S. B.: Hypopotassemia Following Bilateral Uretero Sigmoidostomy , New Engl. J. Med. 244: 326-328, 1951.Crossref 25. Smith, S. G.; Black-Schaffer, B., and Lasater, T. E.: Potassium Deficiency Syndrome in the Rat and Dog , Arch. Path. 49:185-199, 1950. 26. Achor, R. W. P., and Smith, L. A.: Nutritional Deficiency Syndrome with Diarrhea Resulting in Hypopotassemia, Muscle Degeneration and Renal Insufficiency: Report of a Case with Recovery , Proc. Mayo Clin. 30:207-214, 1955. 27. Relman, A. S., and Schwartz, W. B.: The Nephropathy of Potassium Depletion: A Clinical and Pathological Entity , New Engl. J. Med. 255: 195-203, 1956.Crossref 28. Watson, G. M., and Witts, L. J.: Intestinal Macrocytic Anemia , Brit. Med. J. 1:13-17, 1952.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Myoglobinuria and Hypokalemia in Regional Enteritis

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Publisher
American Medical Association
Copyright
Copyright © 1962 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1962.03620190119019
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Abstract

Abstract The occurrence of gross myoglobinuria in man is unusual though it has been reported in a number of circumstances. Most instances have involved either muscle injury or an undefined state in which there is recurrent myoglobinuria often after exercise. In the case to be reported here, myoglobinuria occurred in a setting of metabolic abnormalities induced by regional enteritis and its treatment with cortisone. The clinical and laboratory data suggest that exercise of muscles weakened by potassium and other deficiencies was the cause of the myoglobinuria. Report of a Case A 47-year-old civil engineer was referred to the Pratt Clinic on Oct. 22, 1953, for evaluation of regional enteritis. Six years previously, he had begun to have persistent abdominal pain and aching in various joints. One year later, in 1948, at a celiotomy, 20 cm. of the terminal ileum and the ileocecal valve were found to be indurated and inflamed. The References 1. Biörck, G.: On Myoglobin and Its Occurrence in Man , Acta Med. Scand. ( (Suppl. 226) ) 133:1-216, 1949. 2. Millikan, G. A.: Muscle Hemoglobin , Physiol. Rev. 19:503-523, 1939. 3. Yuile, C. L., and Clark, W. F.: Myohemoglobinuria: A Study of the Renal Clearance of Myohemoglobin in Dogs , J. Exp. Med. 74:187-196, 1941.Crossref 4. Gilligan, D. R., and Blumgart, H. L.: March Hemoglobinuria: Studies of the Clinical Characteristics, Blood Metabolism and Mechanism; with Observations on 3 New Cases, and Review of Literature , Medicine (Balt.) 20:341-395, 1941.Crossref 5. Carlström, B.: Über die Ätiologie und Pathogenese der Kreuzlähme des Pferdes , Skand. Arch. Physiol. 61:161-224, 1931Crossref 6. 63:164-212, 1932. 7. Hed, R.: Myoglobinuria in Man with Special Reference to a Familial Form, Stockholm, Kungl. Boktryckeriet, P. A. Norstedt and Soner, 1955 ; Acta Med. Scand. ( (Suppl. 303) ) 51:1-107, 1955. 8. Bywaters, E. G. L., and Beall, D.: Crush Injuries with Impairment of Renal Function , Brit. Med. J. 1:427-432, 1941.Crossref 9. Bywaters, E. G. L.: Ischemic Muscle Necrosis: Crushing Injury, Traumatic Edema, the Crush Syndrome, Traumatic Anuria, Compression Syndrome; A Type of Injury Seen in Air Raid Casualties Following Burial Beneath Debris , J.A.M.A. 124:1103-1109, 1944.Crossref 10. Bywaters, E. G. L., and Stead, J. K.: Production of Renal Failure Following Injection of Solutions Containing Myohemoglobin , Quart. J. Exp. Physiol. 33:53-70, 1944. 11. Montagnani, C. A., and Simeone, F. A.: Observations on the Liberation and Elimination of Myohemoglobin and of Hemoglobin After Release of Muscle Ischemia , Surgery 34:169-185, 1953. 12. Berlin, R.: Haff Disease in Sweden , Acta Med. Scand. 129:560-572, 1948.Crossref 13. Spaet, T. H.; Rosenthal, M. C., and Dameshek, W.: Idiopathic Myoglobinuria in Man: Report of a Case , Blood 9:881-896, 1954. 14. Bowden, D. H.; Fraser, D.; Jackson, S. H., and Walker, N. F.: Acute Recurrent Rhabdomyolysis (Paroxysmal Myohemoglobinuria): A Report of 3 Cases and a Review of the Literature , Medicine (Balt.) 35:335-353, 1956.Crossref 15. Farmer, T. A., Jr.; Hammack, W. J., and Frommeyer, W. B., Jr.: Idiopathic Recurrent Rhabdomyolysis Associated with Myoglobinuria , New Engl. J. Med. 264:60-66, 1961.Crossref 16. Pearson, C. M.; Beck, W. S., and Blahd, W. H.: Idiopathic Paroxysmal Myoglobinuria , A.M.A. Arch. Intern. Med. 99:376-389, 1957.Crossref 17. Schmid, R., and Mahler, R.: Chronic Progressive Myopathy with Myoglobinuria: Demonstration of Glycogenolytic Defect in Muscle , J. Clin. Invest. 38:2044-2058, 1959.Crossref 18. Acheson, D., and McAlpine, D.: Muscular Dystrophy Associated with Paroxysmal Myoglobinuria and Excessive Excretion of Ketosteroids , Lancet 2:372-375, 1953.Crossref 19. Harrison, H. E.; Tompsett, R. R., and Barr, D. P.: The Serum Potassium in 2 Cases of Sprue , Proc. Soc. Exp. Biol. Med. 54:314-315, 1943.Crossref 20. Ariel, I. M.: Chloridorrhea: Syndrome Associated with Diarrhea and Potassium Deficiency , A.M.A. Arch. Surg. 68:105-116, 1954.Crossref 21. Schwartz, W. B., and Relman, A. S.: Metabolic and Renal Studies in Chronic Potassium Depletion Resulting from Overuse of Laxatives , J. Clin. Invest. 32:258-271, 1953.Crossref 22. Brown, M. R.; Currens, J. H., and Marchand, J. F.: Muscular Paralysis and Electrocardiographic Abnormalities Resulting from Potassium Loss in Chronic Nephritis , J.A.M.A. 124:545-549, 1944.Crossref 23. Holler, J.: Potassium Deficiency Occurring During Treatment of Diabetic Acidosis , J.A.M.A. 131:1186-1189, 1946.Crossref 24. Diefenbach, W. C. L.; Fisk, S. C., and Gilson, S. B.: Hypopotassemia Following Bilateral Uretero Sigmoidostomy , New Engl. J. Med. 244: 326-328, 1951.Crossref 25. Smith, S. G.; Black-Schaffer, B., and Lasater, T. E.: Potassium Deficiency Syndrome in the Rat and Dog , Arch. Path. 49:185-199, 1950. 26. Achor, R. W. P., and Smith, L. A.: Nutritional Deficiency Syndrome with Diarrhea Resulting in Hypopotassemia, Muscle Degeneration and Renal Insufficiency: Report of a Case with Recovery , Proc. Mayo Clin. 30:207-214, 1955. 27. Relman, A. S., and Schwartz, W. B.: The Nephropathy of Potassium Depletion: A Clinical and Pathological Entity , New Engl. J. Med. 255: 195-203, 1956.Crossref 28. Watson, G. M., and Witts, L. J.: Intestinal Macrocytic Anemia , Brit. Med. J. 1:13-17, 1952.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 1, 1962

References