Rhabdomyolysis after correction of hyponatremia due to psychogenic polydipsia possibly complicated by clozapine.

Abstract

OBJECTIVE:

To report a case of rhabdomyolysis related to rapid correction of hyponatremia attributable to compulsive drinking of water, possible complicated by clozapine use.

CASE SUMMARY:

A 42-year-old white man treated with clozapine for schizophrenia was admitted for a generalized seizure. Marked hyponatremia due to psychogenic polydipsia was present. He developed a marked elevation of creatine kinase concentrations after correction of hyponatremia with hyperosmolar sodium solution, without clinical signs of rhabdomyolysis.

DISCUSSION:

Rhabdomyolysis associated with hyponatremia due to water intoxication has been reported in 17 patients to date. A possible explanation may lie within the framework of the calcium-sodium exchange across the skeletal muscle cell membrane. By increasing muscle cell permeability, clozapine treatment may possibly enhance the destruction of muscle cells.

CONCLUSIONS:

Hyponatremia due to water intoxication and concurrent use of clozapine should be considered in the differential diagnosis of rhabdomyolysis, especially in the severely psychiatrically disabled population.

• Authors: J Wicki, O T Rutschmann, H Burri, G Vecchietti, J Desmeules
• Journal: The Annals of pharmacotherapy (Ann Pharmacother) Vol. 32 Issue 9 Pg. 892-5 (Sep 1998) ISSN: 1060-0280 [Print] United States
• PMID: 9762377 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antipsychotic Agents
• Sodium Chloride
• Clozapine

Topics

• Adult
• Antipsychotic Agents (adverse effects, therapeutic use)
• Clozapine (adverse effects, therapeutic use)
• Drinking Behavior
• Humans
• Hyponatremia (complications, physiopathology, therapy)
• Male
• Rhabdomyolysis (chemically induced, etiology)
• Schizophrenia, Paranoid (complications, drug therapy, physiopathology)
• Schizophrenic Psychology
• Sodium Chloride (therapeutic use)