On the Mechanisms Underlying Poisoning-Induced Rhabdomyolysis and Acute Renal Failure

ABSTRACT

The clinical syndrome of rhabdomyolysis is caused by injury of skeletal muscles resulting in release of intracellular muscle constituents. Drug poisoning is one of the causes of severe rhabdomyolysis. Severe electrolyte disorders and acute renal failure may occur in rhabdomyolysis, leading to life-threatening situations. Early initiation of renal replacement therapy can help improve outcome.

In the present retrospective study, medical records of 181 patients suspected of rhabdomyolysis from Loghman-Hakim Hospital in the period of 2004 to 2005 were reviewed. A creatinine phosphokinase (CPK) value of greater than five times normal (≥975 IU/L) was the basis for confirmation of a rhabdomyolysis diagnosis. An increased serum creatinine level of more than 30% was the basis for acute renal failure diagnosis.

Out of 156 patients, 100 were male with an age range of 13 to 78 years. One hundred and two (92%) patients had CPK >975 U/L, and 36 patients (28.6%) had a 30% or more increase in their creatinine level during their admission days. Mean fluid intake was the same in patients with renal failure and those without renal failure. In 8.3% of the cases, multiple drug poisoning was observed. The most common compound overdose associated with rhabdomyolysis was opium.

It is concluded that fluid therapy alone is not adequate in the management of acute renal failure in rhabdomyolysis. Therefore, other etiological factors are involved that remain to be elucidated by further studies.

KEYWORDS:

• Acute Renal Failure
• Poisoning
• Rhabdomyolysis
• Fluid Therapy

This study was supported by the Toxicological Research Center, Loghman Hakim Hospital. Special thanks are given to Dr. Zahed (Nephrologist Consultant), Mrs. Asadi (Toxicological Research Center Officer), Ms. Rostami (Clinical Research Methodologist), and Loghman-Hakim Hospital Laboratory, which supported this investigation.