Objective: 

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.

Method: 

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.

Results: 

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.

Conclusion: 

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.

中文翻译：

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受 COVID-19 大流行影响的自闭症儿童中低钾血症引起的横纹肌溶解症

客观的： 

患有自闭症谱系障碍 (ASD) 的儿科患者通常同时存在喂养障碍。我们希望通过低钾血症引起的横纹肌溶解症的独特病例来强调这些喂养障碍可能对这一患者群体产生的重大影响。

方法： 

我们介绍了一名患有自闭症谱系障碍 (ASD) 的 3 岁男孩的独特病例，该男孩有长期的食物选择性史，在 COVID-19 大流行期间，他的日常生活被打乱，导致回避/限制性食物摄入障碍和严重营养不良，并出现严重的低钾血症和随后发现他的肌酶升高，与横纹肌溶解症一致，尽管只有轻微的行走困难的症状。

结果： 

该患者接受了积极的水合、电解质治疗和鼻胃管饲喂治疗，临床和生化证据显示病情有所改善。他还重新获得了在 COVID-19 大流行期间失效的 ASD 相关护理服务。

结论： 

该病例体现了喂养障碍可能对自闭症谱系障碍患者产生的不利影响，特别是在全球大流行等压力源的情况下，也是第一例有记录的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，医生在评估严重低钾血症患者横纹肌溶解症的临床和实验室证据时应采用较低的阈值，因为低钾血症引起的横纹肌溶解症的症状通常很微妙，这可能会延误诊断，从而增加危及生命的并发症的风险。大范围的肌肉损伤。