Exertional rhabdomyolysis-induced “normokalemic” severe acute kidney injury. A case report and a brief literature review

Rhabdomyolysis is the breakdown of the muscle cells with the resultant leakage of intracellular components. Hyperkalemia and hyperphosphatemia may occur during the disease course, as well as acute kidney injury due to blockade of the tubules by myoglobin released from the muscle cells. Electrolyte disturbances are generally more severe than acute kidney injuries. We would like to report a patient who was diagnosed with exertional rhabdomyolysis-induced acute kidney injury due to vigorous swimming and who required hemodialysis but lacked hyperkalemia. The discrepancy between the severe acute kidney injury and lack of hyperkalemia was remarkable. A brief literature search also revealed several patient reports with hypo- and normokalemia despite experiencing acute kidney injury. Pathophysiologic explanations for this discrepancy include exercise-induced increased kaliuresis and intracellular shifting of potassium.