The association between cocaine use detected on drug screening and rhabdomyolysis

Abstract

Rhabdomyolysis is associated with patients presenting to the emergency department who test positive for cocaine on rapid drug screening, including those neither agitated nor restrained. The aim was to determine patient characteristics, frequency, and severity of cocaine-associated rhabdomyolysis. We studied cocaine-positive patients also tested for rhabdomyolysis with creatine kinase (CK) over a six-year period and recorded demographics, vital signs, disposition, diagnoses, and routine labs. We then compared patients with and without rhabdomyolysis. There were 215 patients. The majority were male, black, middle-aged, and smoked tobacco. Psychiatric, neurological, and cardiovascular final diagnostic groups were most common. Other substances detected on drug screening included ethanol (18%) and amphetamines (36%). Rhabdomyolysis (CK ≥ 1000 U/L) was diagnosed in 54 (25%) patients, with median (IQR) CK of 2052 (1305–4959) and range of 1009–40,647 U/L. There were significant differences in gender, race, disposition, and renal/cardiac laboratory test results between patients with and without rhabdomyolysis. We performed multiple logistic regression analysis to reveal elevated BUN, blunt trauma, male gender, and amphetamines detected on drug screen as associated factors for developing rhabdomyolysis. The frequency of rhabdomyolysis in patients who used cocaine was 25%, with certain associated patient characteristics.