Hypokalemia-Induced Rhabdomyolysis in a Child with Autism Affected by the COVID-19 Pandemic.

A 3-year-old boy with autism had very selective eating habits that got much worse during COVID-19 when his routine changed. He became severely malnourished and developed dangerously low potassium levels, which caused serious muscle damage. He only showed mild walking problems, making it hard to spot how serious his condition was. Treatment included IV fluids, nutrients through a feeding tube, and reconnecting with autism support services.

This case report describes a 3-year-old boy with autism spectrum disorder who developed severe hypokalemia-induced rhabdomyolysis during the COVID-19 pandemic. The child had pre-existing food selectivity that worsened to avoidant/restrictive food intake disorder when his routine was disrupted. This led to severe undernutrition and profound hypokalemia, resulting in rhabdomyolysis (muscle breakdown) with only subtle symptoms of walking difficulty. Treatment included aggressive hydration, electrolyte replacement, nasogastric feeding, and reconnection to autism support services.

This represents the first documented pediatric case of rhabdomyolysis secondary to hypokalemia from severe undernutrition in an autistic child.

Clinicians should maintain high suspicion for rhabdomyolysis in autistic children with severe hypokalemia, even with subtle symptoms. Pandemic-related disruptions may exacerbate feeding disorders. Continuity of autism support services is crucial during crises.

Single case report limits generalizability. No systematic assessment of prevalence or risk factors for this complication in autistic children with feeding disorders.

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. 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. 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. 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.