Rhabdomyolysis is a common and potentially lethal clinical syndrome that results from acute muscle fiber necrosis with leakage of muscle constituents into blood. The authors report on a case of rhabdomyolysis in a 46-year-old patient with the diagnosis of schizophrenia paranoid type.

The patient was admitted with the symptoms of generalized seizure and vomiting; and as severe hyponatremia was proved, its correction with the parallel use of clozapine treatment was done. On the fifth day of his treatment muscle pain and asthenia occurred and creatinine kinase concentration increased to 52090 U/L without any symptoms of neuroleptic malignant syndrome. The course of illness was benignant, clozapine was stopped and during high-volume alkaline diuresis creatinine kinase concentration gradually returned to a normal range. After 6 months follow-up no recurrence of rhabdomyolysis was detected during olanzapine treatment; clinical and laboratory findings were normal.

Rhabdomyolysis was associated with the rapid correction of hyponatremia after water intoxication caused by psychogenic polydipsia and was complicated by clozapine use.

The authors suggest that monitoring creatinine kinase is not necessary routinely by antipsychotic administration, but point at the importance of cautious correction of hyponatremia and of creatinine kinase monitoring beside atypical antipsychotic therapy when patients complain about muscular symptoms and suggest that switch to another atypical antipsychotic after an atypical antipsychotic induced rhabdomyolysis can be a cautious clinical strategy.