Sometimes after reattachment of an amputated limb the patient may become severely ill. This may be severe enough to require reamputation of the limb. A similar syndrome may occur after perfusion of an ischemic limb with severe peripheral artery disease.


Mechanism: Ischemic or necrotic skeletal muscle releases potassium and other intracellular materials/


Clinical features:

(1) fever

(2) soft tissue swelling in the reattached/reperfused limb, with compartment syndrome

(3) changes in consciousness

(4) mild jaundice

(5) acute renal failure (from myoglobinuria)

(6) hemodynamic instability

(7) cardiac arrhythmias (associated with the hyperkalemia)


Laboratory findings:

(1) hyperkalemia

(2) metabolic acidosis (lactic acidosis)

(3) myoglobinuria

(4) elevated creatinine


The diagnosis requires exclusion of other causes such as sepsis.


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