Severe Rhabdomyolysis Possibly Complicated by Quetiapine Use in One Schizophrenic Patient Comorbid with Hyponatremia

Quetiaping引起低血鈉的精神分裂病患嚴重的橫紋肌溶解

精神分裂病患的橫紋肌溶解的病因至今仍不清楚。我們報告一例過度飲水而引起水中毒之精神分裂病患，疑似在quetiapine使用下併發橫紋肌溶解症。32歲慢性精神分裂症男性，出現過度飲水引起的水中毒與癲癇。在快速矯正低血鈉後出現肌酐酸值（CPK） 大民90,000 IU/L，但治療期間並無肌肉外傷、高燒、感染、抗精神病藥物惡性症候群（NMS） 的症狀。診斷為疑似quetiapine引起之橫紋肌溶解症。在停止quetiapine及轉換成amisulpride的兩年，水中毒及橫紋肌溶解完全消失。此個案橫紋肌溶解症之鑑別診斷包含快速矯正低血鈉、癲癇、使用quetiapine。故在疑似因水中毒且合併使用quetiapine治療之精神分裂症病患，在治療期間及矯正低血鈉時應仔細監測。而替換成另一種抗精神病藥物是值得使用的臨床策略。

Causes of rhabdomyolysis among patients with schizophrenia are still unknown. We report one case with schizophrenia developing rhabdomyolysis after rapid correction of hyponatremia possibly complicated by quetiapine. A 32-year-old man with chronic schizophrenia had complex partial seizure with self-induced water intoxication (SIWI) under quetiapine treatment. Substantial elevation of creatine kinase (>90,000U/L) was found without trauma, fever, infection, neuroleptic malignant syndrome (NMS), or acute renal failure after rapid correction of hyponatremia in one day. Quetiapine complicated rhabdomyolysis was diagnosed. The symptoms subsided after switching to amisulpride. In this case, rapid correction of hyponatremia, seizure, and concurrent use of quetiapine should be considered in differential diagnoses of rhabdomyolysis. Psychiatric patients with SIWI being treated with quetiapine should be closely monitored during course of treatment, with special attention to correcting hyponatremia. In addition, it might be benficial to switch to another atypical antipsychotic for antipychotic-induced rhabdomyolysis.