Case report: Severe rhabdomyolysis and acute liver injury in a high-altitude mountain climber
Concurrent severe rhabdomyolysis and acute liver damage are rarely reported in the setting of acute high-altitude illness (AHAI). We described a 53-year-old healthy mountain climber who experienced headache and dyspnea at the summit of Snow Mountain (Xueshan; 3,886 m above sea level) and presented t...
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| Format: | Article |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.917355/full |
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| author | Yun-Chih Yeh Chien-Chou Chen Chien-Chou Chen Shih-Hua Lin |
| author_facet | Yun-Chih Yeh Chien-Chou Chen Chien-Chou Chen Shih-Hua Lin |
| author_sort | Yun-Chih Yeh |
| collection | DOAJ |
| description | Concurrent severe rhabdomyolysis and acute liver damage are rarely reported in the setting of acute high-altitude illness (AHAI). We described a 53-year-old healthy mountain climber who experienced headache and dyspnea at the summit of Snow Mountain (Xueshan; 3,886 m above sea level) and presented to the emergency room with generalized malaise, diffuse muscle pain, and tea-colored urine. His consciousness was alert, and he had a blood pressure of 114/74 mmHg, heart rate of 66/min, and body temperature of 36.8°C. Myalgia of the bilateral lower limbs, diminished skin turgor, dry oral mucosa, and tea-colored urine were notable. Urinalysis showed positive occult blood without red blood cells. The most striking blood laboratory data included creatine kinase (CK) 33,765 IU/L, inappropriately high aspartate aminotransferase (AST) 2,882 IU/L and alanine aminotransferase (ALT) 2,259 IU/L (CK/AST ratio 11.7, CK/ALT ratio 14.9), creatinine 1.5 mg/dl, serum urea nitrogen (BUN) 26 mg/dl, total bilirubin 1.7 mg/dl, ammonia 147 μg/ml, lactate 2.5 mmol/L, and prothrombin time 17.8 s. The meticulous search for the underlying causes of acute liver injury was non-revealing. With volume repletion, mannitol use, and urine alkalization coupled with avoidance of nephrotoxic and hepatotoxic agents, his clinical features and laboratory abnormality completely resolved in 3 weeks. Despite rarity, severe rhabdomyolysis and/oracute liver injury as a potential life-threatening condition requiring urgent management may occur in high-altitude hypobaric hypoxia. |
| first_indexed | 2024-04-13T11:15:22Z |
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| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-13T11:15:22Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj.art-4d103651ec6541e08c1dc29f7d61f1de2022-12-22T02:48:59ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-08-01910.3389/fmed.2022.917355917355Case report: Severe rhabdomyolysis and acute liver injury in a high-altitude mountain climberYun-Chih Yeh0Chien-Chou Chen1Chien-Chou Chen2Shih-Hua Lin3Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDepartment of Internal Medicine, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanConcurrent severe rhabdomyolysis and acute liver damage are rarely reported in the setting of acute high-altitude illness (AHAI). We described a 53-year-old healthy mountain climber who experienced headache and dyspnea at the summit of Snow Mountain (Xueshan; 3,886 m above sea level) and presented to the emergency room with generalized malaise, diffuse muscle pain, and tea-colored urine. His consciousness was alert, and he had a blood pressure of 114/74 mmHg, heart rate of 66/min, and body temperature of 36.8°C. Myalgia of the bilateral lower limbs, diminished skin turgor, dry oral mucosa, and tea-colored urine were notable. Urinalysis showed positive occult blood without red blood cells. The most striking blood laboratory data included creatine kinase (CK) 33,765 IU/L, inappropriately high aspartate aminotransferase (AST) 2,882 IU/L and alanine aminotransferase (ALT) 2,259 IU/L (CK/AST ratio 11.7, CK/ALT ratio 14.9), creatinine 1.5 mg/dl, serum urea nitrogen (BUN) 26 mg/dl, total bilirubin 1.7 mg/dl, ammonia 147 μg/ml, lactate 2.5 mmol/L, and prothrombin time 17.8 s. The meticulous search for the underlying causes of acute liver injury was non-revealing. With volume repletion, mannitol use, and urine alkalization coupled with avoidance of nephrotoxic and hepatotoxic agents, his clinical features and laboratory abnormality completely resolved in 3 weeks. Despite rarity, severe rhabdomyolysis and/oracute liver injury as a potential life-threatening condition requiring urgent management may occur in high-altitude hypobaric hypoxia.https://www.frontiersin.org/articles/10.3389/fmed.2022.917355/fullacute high-altitude illnesshypobaric hypoxiarhabdomyolysisacute kidney injuryabnormal liver function |
| spellingShingle | Yun-Chih Yeh Chien-Chou Chen Chien-Chou Chen Shih-Hua Lin Case report: Severe rhabdomyolysis and acute liver injury in a high-altitude mountain climber Frontiers in Medicine acute high-altitude illness hypobaric hypoxia rhabdomyolysis acute kidney injury abnormal liver function |
| title | Case report: Severe rhabdomyolysis and acute liver injury in a high-altitude mountain climber |
| title_full | Case report: Severe rhabdomyolysis and acute liver injury in a high-altitude mountain climber |
| title_fullStr | Case report: Severe rhabdomyolysis and acute liver injury in a high-altitude mountain climber |
| title_full_unstemmed | Case report: Severe rhabdomyolysis and acute liver injury in a high-altitude mountain climber |
| title_short | Case report: Severe rhabdomyolysis and acute liver injury in a high-altitude mountain climber |
| title_sort | case report severe rhabdomyolysis and acute liver injury in a high altitude mountain climber |
| topic | acute high-altitude illness hypobaric hypoxia rhabdomyolysis acute kidney injury abnormal liver function |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.917355/full |
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