Background Rhabdomyolysis (RM), characterized by myoglobinuria, hyperkalemia, and cardiac arrhythmias, poses a risk to renal tubules, leads to acute kidney injury and potentially life-threatening consequences. However, the symptoms of RM triggered by hyperosmolar hyperglycemic syndrome (HHS) in clinical practice often remain concealed and easily be overlooked.

Objective To analyze the clinical characteristics and factors associated with HHS combined RM in our hospital, and explore its preventive and treatment strategies.

Methods A retrospective analysis was conducted on medical records of HHS patients admitted to our hospital from February 2009 to July 2021. Patients were divided into HHS with RM group and HHS group based on the presence of RM. Clinical features and biochemical indicators were compared between the two groups, and Pearson test was used to analyze the correlation between variables. Additionally, multiple linear regression analysis was employed to identify factors contributing to elevated levels of creatine kinase (CK) in HHS patients. Finally, the outcomes of different patients after treatment, including fluid resuscitation, glycemic control, electrolyte correction, and anti-infective therapy, were analyzed.

Results A total of 31 HHS patients were included in this study, of which 9 had concurrent RM. Compared with the HHS group, patients in the HHS combined with RM group had higher mean age (P=0.011), prevalence of acute kidney injury (P=0.037), AST level (P=0.011), blood sodium level (P=0.003), plasma effective osmolality (P=0.001), creatinine (P=0.004), and urea nitrogen (P=0.001) levels, and the differences were all statistically significant. Creatine kinase level was positively correlated with CK-MB (r=0.442, P=0.018), AST (r=0.389, P=0.031), blood chloride (r=0.395, P=0.028), blood sodium (r=0.537, P=0.002), effective plasma osmolality (r=0.830, P=0.001), creatinine (r=0.513, P=0.003) and urea nitrogen levels (r=0.772, P=0.001), and while it was negatively correlated with blood calcium levels (r=-0.448, P=0.011). Multiple linear regression analysis revealed that AST (β=0.503, P=0.010), effective plasma osmolality (β=0.356, P=0.026), creatinine level (β=0.709, P=0.023) and urea nitrogen (β=-0.862, P=0.013) were independent correlates leading to an increase in creatine kinase level in HHS patients. A total of 29 cases were discharged with improvement after treatment, and creatine kinase and myoglobin decreased to normal in 5 cases in the HHS combined RM group.

Conclusion The development of RM in HHS patients is closely associated with plasma osmolality and creatinine levels. Therefore, heightened vigilance is warranted when encountering elevated indicators in HHS patients during clinical management.