A CASE OF RHABDOMYOLYSIS ASSOCIATED WITH A USE OF INTRAVENOUS VASOPRESSIN

Abstract

We report a case of rhabdomyolysis associated with a continuous infusion of vasopressin (VP) used in the treatment of acute gastrointestinal bleeding.
A 68-year-old man with alcoholic liver cirrhosis was admitted to the hospital because of massive anal bleeding. Endoscopy showed no active bleeding site in the esophagus, stomach, duodeum and colon. Bleeding from the small intestine was suspected and an open laparotomy was performed. During surgery, no bleeding point was found and portal vein pressure was 30mmHg. After the operation, gastrointestinal bleeding continued, and a continuous intravenous VP infusion was started at a rate of 0.2U/min. Ten hours after administration of VP, skin mottling in the lower extremitis were noted. The serum myoglobin level was 17, 100ng/ml. Rhabdomyolysis due to VP was diagnosed, and the VP infusion was suspended. But because of exacerbation of the gastrointestinal bleeding, VP infusion was resumed at a rate of 0.1U/min. Transjugular intrahepatic portosystemic shunt (TIPS) was performed and portal vein pressure was markedly reduced after TIPS. But the skin mottling extended to the truncus. The patient died of multiple organ failure and sepsis.
As far as we could review, only seven cases of rhabdomyolysis associated with a continuous infusion of vasopressin have been reported.