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A critically ill child with dark urine
  1. Amir Zayegh1,
  2. Joy Lee2,
  3. Heidi Peters2,
  4. Daryl Efron1
  1. 1General Medicine Department, The Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
  2. 2Metabolic Medicine, The Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Amir Zayegh, General Medicine Department, The Royal Children’s Hospital Melbourne, Melbourne, Victoria 3052, Australia; amir.zayegh{at}rch.org.au

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A 2-year-old boy with mild gross motor delay presented to a local hospital with a 24-hour history of lethargy, cough and decreased mobilisation. On examination, he had normal vital signs, coryza, clear chest and generalised muscle tenderness with symmetrically reduced power in all limbs. Serum creatine kinase (CK) was 140 000 U/L (RR:<240) and serum potassium peaked at 10 mmol/L (RR: 3.5–5.0) despite diuretics, insulin and dextrose infusions. The child developed ventricular tachycardia progressing to asystole. He was intubated and had 2 hours of cardiopulmonary resuscitation on route to the tertiary paediatric centre, where he was placed on extracorporeal membrane oxygenation for 3 days. The boy had severe renal impairment with a peak creatine of 336 micromol/L (RR: 20–60) and received haemofiltration for 14 days. He developed severe coagulopathy, bilateral compartment syndrome of his lower limbs requiring fasciotomy, and required respiratory support for 2 months. The child had residual calf muscle atrophy and was unable to …

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