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May 1973

Myopathic-Nephrotic-Metabolic Syndrome and Massive Acute Arterial Occlusions

Arch Surg. 1973;106(5):628-629. doi:10.1001/archsurg.1973.01350170002002

Reestablishment of arterial flow to an extremity following an acute arterial occlusion results in its morphologic and functional recovery in a large percentage of cases. However, in a small number of instances, even if arterial patency is achieved, a complex myopathic-nephrotic-metabolic syndrome may be observed leading often to loss of limb and life.

In 1960, I first described two cases of arterial embolism associated with a syndrome of acute massive ischemic myopathy, myoglobinuria, hyperkalemia, and metabolic acidosis.1 To date, I have personally observed a total of nine patients with such complications following acute arterial embolic or thrombotic obstructions. In these patients, the striking features were the unusual nature and great severity of both local and systemic manifestations.

Such a syndrome may occur during the acute ischemic or devascularization phase, and after revascularization of the extremity. The clinical and metabolic findings in these cases are characteristic.1,2 The clinical imprint

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