Fatal rhabdomyolysis and disseminated intravascular coagulation after total knee arthroplasty under spinal anesthesia: A case report

Table 1 Serial changes in the laboratory parameters in perioperative period

Time	CK, 56-244 IU/L	AST, 5-37 U/L	LDH, 160-520 U/L	BUN, 8-22 mg/dL	Cr, 0.8-1.2 mg/dL	K, 3.5-5.0 mEq/L	Platelet count, 150-400 ×103/mL	PT/aPTT, 10.4-13.5/36.0-39.0 s	PT INR, 0.85-1.15 INR	Fibrinogen, 170-410 mg/dL	D-dimer, 0-0.55 mg/mL	FDP, 0-5 mg/mL	pH
Preop.		27		11	0.8	4.1	111	11.3/30.8	1
After surgery	111	26		10.4	0.7	3.5	91	12.2/28.8	1.09	198	4.14	10.2
19 h after surgery (next day morning)	2763	93		15.2	1	3.5	52	13.8/32.8	1.24	150	80	148	7.383
31 h after surgery (during ICU)		121	464	20.4	1.2	3.7	44	17.3/37.9	1.58	361	48.3	117	7.406
33 h after surgery (during CPR)	3455	128	502	19.5	1.4	5.3	16	31.7/120.3	3.02	171	80	140	7.511

aPTT: Activated partial thromboplastin time; AST: Aspartate transaminase; BUN: Blood urea nitrogen; CK: Creatine kinase; CPR: Cardiopulmonary resuscitation; Cr: Creatinine; FDP: Fibrinogen degradation product; ICU: Intensive care unit; INR: International normalized ratio; LDH: Lactate dehydrogenase; PT: Prothrombin time.

Table 2 Serial vital signs in the perioperative period

Time	SBP in mmHg	DBP in mmHg	HR in beats/min	BT in ℃	SpO2, %	Progress note
Before surgery	120	70	50	36.6	100	After arrival on operation room
After surgery	95	58	48	35.8	100	During recovery room
6 h after surgery	120	70	61	36.4	100
12 h after surgery	100	60	75	36.1	100
24 h after surgery	110	70	110	37.9	90	Drowsy mental state
28 h after surgery	100	70	103	36.6	98	During ICU, mental state was recovered
31 h after surgery	100	60	113	38	96
33 h after surgery	50	20	37		52	During CPR

BT: Body temperature; CPR: Cardiopulmonary resuscitation; DBP: Diastolic blood pressure; HR: Heart rate; ICU: Intensive care unit; SBP: Systolic blood pressure; SpO₂: O₂ saturation by pulse oximetry.