pituitrin and Rhabdomyolysis

A 73-year-old man with alcoholic liver cirrhosis was admitted to our hospital because of massive hematemesis. He was treated with continuous intravenous infusion of vasopressin of 0.2 U/min. 22 hours after the infusion, he complained of myalgia, muscle weakness and skin mottling in the extremities. The skin lesion extended to the back. The serum CK and myoglobin levels were elevated to 52,280 IU/L and 84,400 ng/ml respectively. The urinary myoglobin level was elevated to 732,000 ng/ml. On the fifth hospital, he died of bleeding from the esophageal varices. Autopsy examination demonstrated necrosis of the skeletal muscle cells and myoglobin casts in the renal tubules. Our patient was probably hypersensitive to vasopressin because of underlying liver dysfunction. The massive myonecrosis might be induced from the following conditions; overreactive vasopressin-induced vasoconstriction resulted in ischemic muscle damage, and hypersensitive sarcoplasmic reticulum released excessive Ca2+ followed by muscle hypercontraction as seen in malignant syndrome or malignant hyperthermia.

Topics: Aged; Esophageal and Gastric Varices; Humans; Infusions, Intravenous; Liver Cirrhosis, Alcoholic; Male; Muscle, Skeletal; Necrosis; Rhabdomyolysis; Vasopressins

We describe the case of a patient with hepatic cirrhosis treated with an intravenous infusion of vasopressin to control an upper digestive hemorrhage, who developed distance cutaneous necrosis and rhabdomyolysis. We review the other cases published in the international scientific literature and we discuss the possible pathogeny of these complications.

Topics: Gastrointestinal Hemorrhage; Humans; Infusions, Intravenous; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Necrosis; Rhabdomyolysis; Skin; Vasopressins

A patient is described who developed liver cirrhosis and variceal bleeding. After a continuous infusion of vasopressin rabdomyolysis occurred. Recovery of the clinical picture and of the muscle enzymes occurred 48 hours after cessation of therapy.

Topics: Humans; Infusions, Intravenous; Male; Middle Aged; Rhabdomyolysis; Vasopressins

A continuous IV infusion of vasopressin was administrated to a patient with cirrhosis of the liver and acute gastrointestinal bleeding from esophageal varices. In the first 24 hours, the patient developed rhabdomyolysis and cutaneous necrosis. Stopping vasopressin infusion resulted in relief of these lesions. The rarity of these complications suggests an idiosyncratic reaction of susceptible individuals that may be related to previous vascular disease or a failure in baroreceptor regulation.

Topics: Aged; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Infusions, Intravenous; Liver Cirrhosis; Male; Necrosis; Rhabdomyolysis; Skin Diseases; Vasopressins

Topics: Addison Disease; Child; Diabetes Mellitus, Type 1; Humans; Hyponatremia; Male; Natriuresis; Polyendocrinopathies, Autoimmune; Rhabdomyolysis; Vasopressins

Topics: Diagnosis, Differential; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Polydipsia, Psychogenic; Rhabdomyolysis; Vasopressins; Water Intoxication

A patient with acute esophageal variceal bleeding developed fatal rhabdomyolysis during treatment with a continuous intravenous infusion of vasopressin. Signs of ischemia, including mottling of skin and painful extremities, preceded the development of the characteristic electrolyte abnormalities and cardiac arrhythmias. No other recognized causes of rhabdomyolysis were identified on retrospective review of the hospital course. There are several factors which might promote a peripheral ischemic response to vasopressin in the bleeding cirrhotic patient, including altered resting hemodynamics, increased resting sympathetic tone, impaired vasodilation as a compensatory response to vasopressin, and reduced hepatic drug clearance. Idiosyncratic factors involving vasopressin receptor affinity and distribution, vasopressin-associated vasodilation in some vascular beds, and the effect of vasopressin on the renin-angiotensin system may further contribute to impaired tissue perfusion. These multiple overlapping factors probably lead to rhabdomyolysis in a minority of patients receiving vasopressin infusion.

Topics: Aged; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Infusions, Intravenous; Male; Rhabdomyolysis; Risk Factors; Vasopressins

Topics: Adult; Drinking; Fever; Humans; Male; Psychophysiologic Disorders; Rhabdomyolysis; Vasopressins; Water Intoxication

Myoglobinuria and acute renal failure were observed in two patients with vasopressin-treated gastrointestinal hemorrhage. Because there were no other obvious causes of renal failure in either patient, we propose that skeletal muscle ischemia developed during vasopressin infusion, followed by release of myoglobin and renal damage. This association should be considered in the period after vasopressin-treated gastrointestinal hemorrhage.

Topics: Acute Kidney Injury; Aged; Female; Gastrointestinal Hemorrhage; Humans; Infusions, Parenteral; Ischemia; Male; Middle Aged; Muscles; Myoglobinuria; Rhabdomyolysis; Vasopressins