Department of Pediatrics, Boston Children's Hospital, Boston, MA; and.
Department of Pediatrics, Boston Medical Center, Boston, MA.
J Dev Behav Pediatr. 2022;43(5):e356-e360. doi: 10.1097/DBP.0000000000001035. Epub 2021 Nov 3.
Pediatric patients with autism spectrum disorder (ASD) often have coexisting feeding disorders. We hope to emphasize the significant implications that these feeding disorders can have on this patient population through a unique case of hypokalemia-induced rhabdomyolysis.
We present a unique case of a 3-year-old boy with ASD and a longstanding history of food selectivity whose routine was disrupted during the COVID-19 pandemic resulting in avoidant/restrictive food intake disorder and severe undernutrition, who presented with profound hypokalemia and was subsequently found to have elevated muscle enzymes consistent with rhabdomyolysis despite only subtle complaints of difficulty walking.
The patient was treated with aggressive hydration, electrolyte therapy, and nasogastric tube feeds, which resulted in clinical and biochemical evidence of improvement. He was also reconnected to ASD-related care services that had lapsed during the COVID-19 pandemic.
This case exemplifies the adverse impact that feeding disorders can have on patients with ASD, particularly in the setting of stressors such as a global pandemic, and is also the first documented pediatric case of rhabdomyolysis secondary to hypokalemia from severe undernutrition. It demonstrates that physicians should have a low threshold to assess for clinical and laboratory evidence of rhabdomyolysis in patients with profound hypokalemia because symptoms of hypokalemia-induced rhabdomyolysis can often be subtle, which can delay diagnosis and thereby increase the risk for life-threatening complications from extensive muscle damage.
患有自闭症谱系障碍（ASD）的儿科患者常伴有并存的进食障碍。我们希望通过低钾血症引起的横纹肌溶解症这一独特病例来强调这些进食障碍对这一患者群体的重要影响。
我们报告了一例 ASD 患儿的罕见病例，该患儿有长期的食物选择性，在 COVID-19 大流行期间，其日常饮食受到干扰，导致回避/限制型进食障碍和严重营养不良，表现为严重低钾血症，随后发现肌肉酶升高，符合横纹肌溶解症，尽管仅轻微主诉行走困难。
该患者接受了积极的水化、电解质治疗和鼻胃管喂养，结果在临床和生化方面都有改善。他还重新接受了 ASD 相关的护理服务，这些服务在 COVID-19 大流行期间已经中断。
该病例说明了进食障碍对 ASD 患者的不良影响，尤其是在大流行等压力环境下，也是首例因严重营养不良导致低钾血症继发横纹肌溶解症的儿科病例。它表明，医生应该对有严重低钾血症的患者进行横纹肌溶解症的临床和实验室评估，因为低钾血症引起的横纹肌溶解症的症状可能很轻微，这可能会延迟诊断，从而增加广泛肌肉损伤导致危及生命的并发症的风险。
