Rhabdomyolysis is a potentially fatal disorder characterized by elevated serum levels of creatinine kinase (CK) as a result of skeletal muscle injury. The leakage of cellular contents into the circulation can result in electrolyte disturbance, acidosis, clotting abnormality, hypovolaemia, compartment syndrome, and can rapidly progress to acute renal failure. Dialysis may be required in 50 –70% of all diagnosed cases, however with prompt diagnosis and aggressive treatment a return to full renal function is favourable. Rhabdomyolysis is more common in diabetics than the general population, and in the United States the syndrome accounts for 7- 15% of all reported cases of acute renal failure. The causes of rhabdomyolysis are multifactorial but include endocrine disorders, muscle ischaemia and infection.

Hyperosmolar non-ketotic coma (HONK) is a life threatening endocrine disorder manifested by extreme elevated blood glucose levels, hyperosmolarity and the absence of ketosis. It is common in Type 2 diabetics who have enough circulating insulin to suppress the production of ketones, yet not enough to prevent hyperglycaemia. In recent years the increasing prevalence of Type 2 diabetes has increased the likelihood of encountering HONK in the healthcare setting. Aggressive treatment is required to promote a favourable outcome, with rhabdomyolysis being one of the complications of inadequate treatment.

In 2007 patient A was found unconscious in his truck, near to death. On admission to hospital he was found to have HONK, complicated by rhabdomyolysis, acute renal failure and sepsis. This is his story.