Nontraumatic rhabdomyolysis and acute renal failure

Acute Kidney Injury Due to Rhabdomyolysis in Narcotic Drug Users

Background

Regular or illegal drugs and toxins are the most frequent non-physical causes of rhabdomyolysis (RM) in peacetime. Acute Kidney Injury (AKI) is a serious and, sometimes, fatal complication of RM. It occurs in 8–20% of RM incidents.

Methods

In this prospective study we evaluated the severity of RM and AKI in narcotic drug users. From January 2001 to December 2007, 21 patients (17 males, mean age 27.8±4.8 years) with RM associated with AKI were classified into two groups: 11 heroin users (HU) and 10 non-heroin users (NHU). The severity of RM was evaluated by estimation, on admission, of serum creatine phosphokinase (CPK), serum glutamic oxaloacetic transaminase (SGOT), lactate dehydrogenase (LDH), phosphate (PO4) and calcium (Ca) and by the presence of paraplegia (PPL). The severity of AKI during hospitalization was evaluated by estimation of serum creatinine (CR), the presence of oligoanuria (OA), the days of hospitalization (DH), the total of hemodialysis treatments (THD) and the number of patients who received blood transfusions (BT).

Results

RM was much more severe in HU than in NHU. Mean SGOT, CPK, LDH, and P values on admission were higher in HU. Hypocalcemia was statistically more severe in HU. Nine HU were admitted with PPL vs. 1 NHU. Serum CR levels were higher and oligoanuria was much more common in HU. HU had a longer hospitalization period and underwent a bigger number of HT. More HU took BT.

Conclusions

The results of this study suggest that both RM and ARF are more severe in HU than in NHU possibly due to an additional myotoxic effect of heroin.

A case report of myolysis during high-dose amiodarone therapy for uncontrolled ventricular tachycardia

We report a rare case of a 41-year-old male patient, a professional musician, with dilated cardiomyopathy and sustained ventricular tachycardia (VT) that was refractory to class I antiarrhythmic drugs. Severe myolysis developed after 10 months' administration of amiodarone (400 mg/day) in combination with mexiletine (300 mg/day) and disopyramide (400 mg/day). He had been suffering from severe moving muscle pain and an extremely high (16,830) IU/ml) serum level of creatine kinase (CK). The dosage of amiodarone was reduced from 400 mg/day to 200 mg/day without reduction of mexiletine or disopyramide and the patient's symptoms diminished. However, sustained VT developed, and so the dosage of the drug was increased to 250 mg/day. The high serum level of CK also decreased and returned to the normal range after the reduction in amiodarone dosage. Electrophysiologic examination of moving muscle revealed normal motor and sensory conduction velocities and, furthermore, the electromyogram revealed normal potentials and normal motor units. We conclude that severe myolysis developed as a result of the high dose and chronic administration of amiodarone. This is the first report of a Japanese patient showing rare and serious adverse effects in response to amiodarone treatment.

Fatal posture- and heroin-related intestinal infarction and leg muscle necrosis after snorting heroin. A case report

We present a case of a male patient who spent several hours sitting with legs crossed and upper body bent forward after nasal insufflation of heroin (snorting). Death occurred 3 days later as a result of leg muscle necrosis and intestinal ileus with infarction. The autopsy findings, including microthrombi in small mesenteric vessels and necrosis of the leg muscles, were attributed to vascular compression due to the man's position and to metabolic processes resulting from drug ingestion.

Acute renal failure due to McArdle's disease

A 37-year-old previously fit man developed acute renal failure associated with rhabdomyolysis following a brief period of strenuous exercise. Subsequent muscle biopsy and ischaemic arm exercise confirmed the diagnosis of McArdle's disease. This case illustrates that McArdle's disease can present with acute renal failure in the absence of a past history of exercise-induced muscle pain and stiffness.