Rhabdomyolysis and the Use of Low-Dose Amphetamine

Cases journal, 2009

Rhabdomyolysis is a potentially life-threatening condition resulting from the release of large quantities of myocyte breakdown products into the circulation, following injury to striated muscles. There are several causes of rhabdomyolysis - traumatic and non-traumatic. We present a 21-year-old male intravenous drug abuser, who was referred to us with fever, altered sensorium and seizures. He developed severe rhabdomyolysis following a mixed meningeal infection by Streptococcus pneumoniae and Mycobacterium tuberculosis. This patient's examination and investigation suggested a combination of factors leading to the severe rhabdomyolysis which proved fatal. The patient's creatine phosphokinase was elevated to 167,000 U/L, following hyperpyrexia, seizures, meningitis (pneumococcal and tuberculous), pentazocine and alcohol abuse. The increase in mortality rate with the onset of rhabdomyolysis warrants immediate cessation of the insult and aggressive management.

Journal of Medical Cases

Rhabdomyolysis describes a clinical syndrome in which striated muscle breaks down and intracellular contents are released into the circulation. Exertional rhabdomyolysis can be caused by a new, intense workout routine or a change in intensity of an existing one. The severity of presentation varies from asymptomatic creatine kinase (CK) elevations to life-threatening renal failure, disseminated intravascular coagulation, cardiac dysrhythmias and/or compartment syndrome. Our case describes a patient with exertional non-traumatic rhabdomyolysis caused by a mild workout routine change with markedly elevated CK level. There was no evidence of any concomitant renal failure or other aberrancies, such as compartment syndrome, electrolyte abnormalities or electrocardiogram changes. Although the patient reports this as his initial episode of such symptoms, inherited metabolic disorders and genetic mutations should be considered and further workup performed. To the best of our knowledge, this is a rare case of a significantly elevated CK resulting from modest exercise that did not result in acute kidney injury.

2020

Patient of male gender, aged 33, 164 cm tall and weighed 67 kg presented to the emergency room with severe pain in the legs, ascribing the discomfort to an intense workout consisting of indoor exercise-biking for two hours done 3 days prior, after having spent a long period out of practice, he also reported dark urine for the past 24 h. At first, the patient denied having taken medication or drugs but later he declared the assumption of cocaine on the day before the occurrence of the symptoms and his mother reported home therapy, started 3 months earlier, with the selective serotonin reuptake inhibitor (SSRI)-type antidepressant escitalopram (10 mg once a day). In addition, the patient acknowledged the assumption of 60 mg of the serotoninnorepinephrine reuptake inhibitor (SNRI) duloxetine, which had been taken without any medical prescription on the day before the event with the purpose of potentiating the effects of cocaine. The first blood and instrumental checks at the emergency room revealed the presence of severe rhabdomyolysis, thus the

CRC Press eBooks, 2003

Purpose. A case of rhabdomyolysis associated with the use of Hydroxycut is reported. Summary. An 18-year-old Caucasian man arrived at an urgent care center complaining of bilateral leg pain and weakness. His creatine kinase (CK) concentration was 13,220 IU/L. He was diagnosed with rhabdomyolysis and instructed to go to the emergency room. He admitted to decreased urine output for four to five days before hospital admission. He had no significant past medical history, and his medications before symptom onset included Hydroxycut four caplets by mouth daily, naproxen sodium 220 mg by mouth as needed for pain, dextroamphetamine saccharate-amphetamine salts (Adderall) 15 mg by mouth once five days prior for a school examination, and hydrocodoneacetaminophen and cyclobenzaprine for pain. His social history revealed a recent increase in his exercise regimen, and his last alcoholic beverage was consumed five days prior. Upon admission, laboratory tests revealed elevated concentrations of CK, serum creatinine (SCr), aspartate

Sao Paulo Medical Journal, 2005

Canadian family physician Médecin de famille canadien, 2012

a b s t r a C t rhabdomyolysis is a potentially life-threatening syndrome that can develop from a variety of causes; the classic findings of muscular aches, weakness and tea-coloured urine are non-specific and may not always be present. the diagnosis therefore rests upon the presence of a high level of suspicion of any abnormal laboratory values in the mind of the treating physician. an elevated plasma creatine kinase (CK) level is the most sensitive laboratory finding pertaining to muscle injury; whereas hyperkalaemia, acute renal failure and compartment syndrome represent the major life-threatening complications. the management of the condition includes prompt and aggressive fluid resuscitation, elimination of the causative agents and treatment and prevention of any complications that may ensue. the objective of this review is to describe the aetiological spectrum and pathophysiology of rhabdomyolysis, the clinical and biological consequences of this syndrome and to provide an appraisal of the current data available in order to facilitate the prevention, early diagnosis and prompt management of this condition. K e y w o r d s Creatine kinase, rhabdomyolysis, muscle weakness, myoglobin, myoglobinuria i n t r o d u C t i o n Rhabdomyolysis is a potentially life-threatening syndrome characterised by the breakdown of skeletal muscle resulting in the subsequent release of intracellular contents into the circulatory system. These cell contents include enzymes such as creatine kinase (CK), glutamic oxalacetic transaminase, lactate dehydrogenase, aldolase, the haeme pigment myoglobin, electrolytes such as potassium

Human & Experimental Toxicology, 2007

American Journal of Biomedical Science & Research, 2019

Objective: Rhabdomyolysis, a potentially fatal syndrome, is characterized by degradation of muscular skeletal tissue trigger fatal complications such as acute renal failure. Methods: Clinical evaluation and biochemical measurements were performed on a Brazilian soldier after he was admitted at the emergency department of the Military Hospital of Manaus in August 2014. A 23-year-old soldier reported having consumed about six grams of cocaine. Results: Clinical laboratory measurement of serum showed a significant increase in the levels of indirect markers of muscle lysis. Serum creatine kinase fraction MM (CK) level increased up to 99.500 U/L and creatine kinase MB fraction (CK-MB) up to 6.500U/L. Changes in electrolytes also increased (sodium=1.730mmol/L, potassium=42.1mmol/L, phosphorus =48.3mg/dl, chlorine =1.243mmol/L and magnesium=36.1mg/dl). Changes in kidney functions also occurred (urea =302.6mg/dl and creatinine=11.1mg/dL). The levels of albumin (33.4g/dl) and lactate dehydro...

Critical Care, 2005

Rhabdomyolysis ranges from an asymptomatic illness with elevation in the creatine kinase level to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure and disseminated intravascular coagulation. Muscular trauma is the most common cause of rhabdomyolysis. Less common causes include muscle enzyme deficiencies, electrolyte abnormalities, infectious causes, drugs, toxins and endocrinopathies. Weakness, myalgia and tea-colored urine are the main clinical manifestations. The most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration.