Part 2.
Upon returning to his hotel Lincoln showers and attempts to rest before going to dinner with his wife. While resting on the bed shortly after his shower he experienced muscle cramps and twitch in random locations—first his lower limbs, then abdomen, followed by upper limbs, facial musculature and other locations. He couldn’t stay in one position for more than what seemed like a few seconds, and opts to skip dinner.

At 2:30 in the morning he and his wife went to the local E.R. and the following were determined during his examination by the attending physician.

Physical examination:

• Heart rate 80
• Respiratory rate 25/minute and shallow
• Blood pressure 117/67
• Rectal temperature 101°F
• Disseminated intravascular coagulation
• Patient is unable to urinate

• Heme pigment in urine
• Serum levels
  • potasium 6.8 mEq/liter
  • sodium 126 mEq/liter
  • glucose 35 mEq/dl
  • creatine kinase 3,000 I/UL
  • urea nitrogen 10 mg/dl
  • creatine 1.7 g/dl
• Blood smear demonstrated fragmented RBCs

The patient was immediately admitted to the I.C.U. and treated over a 24 hour period with

• nine liters of IV fluids composed of 50% isotonic saline to which 75 mmol/L sodium
  bicarbonate was added.
• IV fluids were supplemented with 10ml/hour of 15% mannitol.
• IV administration of furosemide and allupurinol

Within 24 hours the patient was moved to the renal unit of the hospital, and ultimately
discharged within 72 hours of admission to the hospital.

What is your diagnosis for this patient?