Acute Myoglobinuria Associated With Heroin Addiction

Abstract

Acute rhabdomyolysis was observed as a new complication of intravenous heroin-adulterant injections in four men. Clinical features included generalized muscle tenderness, edema, and profound weakness. Myoglobinuria was detected by a specific immunological method which measured levels up to 3.25 mg/ml. Serum myoglobin levels as high as 0.310 mg/ml were found, with serum creatine phosphokinase levels up to 14,000 units. Needle electromyography showed myopathic motor unit potentials in all muscles tested, most marked proximally. Histologic examination demonstrated acute myolysis, and in one case an unusual picture consistent with tubular aggregates. Renal failure occurred in two patients, one of whom survived. Resolution of weakness varied from two to six weeks. The process recurred in one patient following a subsequent heroin injection.