Case Of Rhabdomyolysis Research Articles

Exercise-Associated Hyponatremic Encephalopathy, Rhabdomyolysis, and Acute Kidney Injury While Hiking in the Grand Canyon.

We present an unusual case of concomitant exercise-associated hyponatremic encephalopathy (EAHE), exertional rhabdomyolysis (ER), and acute kidney injury (AKI) in a Grand Canyon hiker. Our case patient, an adult 41-year-old male, consumed an excessive amount of water during his descent into the Canyon during hot weather. The next day, he was unable to hike out due to severe leg pain and disorientation, and ultimately evacuated by helicopter, having a grand mal seizure in flight. Despite having no serum sodium level, medics administered an intravenous (IV) bolus of 3% hypertonic saline (HTS) before transporting him to the hospital. There, he was diagnosed with EAHE (serum sodium, 114 mmol⋅L-1), ER, bilateral compartment syndromes, and mild AKI. The life-threatening EAHE was immediately corrected with more IV HTS, the limb-threatening compartment syndromes by surgical fasciotomies, and eventually, the AKI by oral and IV fluids. This case demonstrates the seriousness of overconsumption of water, as well as the potential complications of muscle damage when a deconditioned person does prolonged, strenuous exercise. Furthermore, it also illustrates the importance of considering EAHE within the differential diagnosis for acute alterations in level of consciousness. Lastly, it shows the importance to prioritize patient treatments for conditions that are an immediate threat to life or limb.

12375 Rhabdomyolysis As A Cause Of PTH-independent Hypocalcemia In A Child With Acute Influenza Infection

Abstract Disclosure: S. Bhattarai: None. K. Halpin: None. Introduction: Hypocalcemia is characterized by low blood calcium level. Normal range for calcium for ages 12- 19-year is 8.5-10.6 mg/dli . Severe hypocalcemia is considered as serum calcium level of <7 mg/dl. Hypoparathyroidism, pseudohypoparathyroidism and Vitamin D deficiency are some of the most common causes encountered by pediatrician endocrinologists. Rhabdomyolysis with hypocalcemia and elevated PTH is a rare presentation that should be considered, particularly for children presenting with acute viral illness. We present a rare case of rhabdomyolysis associated with hypocalcemia not related to hypoparathyroidism. Case: A 12-year-old female presented to the ED with body ache, poor oral intake and vomiting. She was found to be influenza positive. Labs showed hypocalcemia (4.8 mg/dl). She had an undetectable 25-OH vitamin D level (<5 ng/ml) and elevated iPTH level (609 pg/ml). We discussed the possibility of her etiology of hypocalcemia as Vitamin D deficiency although her presentation was atypical at an older age with negative imaging for rickets, hyperphosphatemia (6.0 mg/dl), and normal ALP (334 unit/L). She did not have any phenotypic features of Albright’s hereditary osteodystrophy with normal renal function. She had elevated CK (4829 U/L) supporting rhabdomyolysis secondary to acute influenza as a cause of her hypocalcemia. Rhabdomyolysis, a known complication of influenza infection, causes cell membrane destruction which impairs the normal function of Na-K-ATPase channel leading to increase in intracellular sodium activating Na/Ca exchanger. This in turn causes influx of calcium intracellularly causing hypocalcemia. Additionally, any injury leads to high phosphorus release from cells due to its lysis. High phosphorus is also caused by reduced oxidative metabolism in muscles impairing phosphate use. This excess of phosphate then combines with calcium and causes calcium-phosphate complex in soft tissues. Hyperphosphatemia additionally inhibits 1 alpha hydroxylase limiting formation of calcitriol leading to hypocalcemia. iiConclusion: Our patient had severe hypocalcemia due to influenza-related rhabdomyolysis. Rhabdomyolysis is an important cause of hypocalcemia in children, especially with acute viral illness. Accordingly, it is also important to obtain serum electrolytes in patients presenting with rhabdomyolysis as hypocalcemia may lead to complications like seizures and cardiac arrhythmia. Endnotes:i Roizen, Jeffrey & Shah, Vipul & Levine, Michael & Carlow, Dean. (2013). Determination of Reference Intervals for Serum Total Calcium in the Vitamin D-Replete Pediatric Population. The Journal of clinical endocrinology and metabolism. 98. 10.1210/jc.2013-3105.ii Ding LN, Wang Y, Tian J, Ye LF, Chen S, Wu SM, Shang WB. Primary hypoparathyroidism accompanied by rhabdomyolysis induced by infection: A case report. World J Clin Cases. 2019 Oct 6;7(19) Presentation: 6/2/2024

Let's Break It Down! A Case of Hypokalemia-Induced Rhabdomyolysis

Let's Break It Down! A Case of Hypokalemia-Induced Rhabdomyolysis

A Late and Delayed Case of Rhabdomyolysis with Trabectedin Use

A Late and Delayed Case of Rhabdomyolysis with Trabectedin Use

Exertional rhabdomyolysis: an analysis of 321 hospitalised US military service members and its relationship with heat illness

IntroductionExertional rhabdomyolysis is a syndrome of muscle breakdown following exercise. This study describes laboratory and demographic trends of service members hospitalised for exertional rhabdomyolysis and examines the relationships with heat...

Levetiracetam-induced Rhabdomyolysis - A Rare Complication

Background: Levetiracetam is an anti-epileptic drug that works by modulation of synaptic neurotransmitter release through binding to the synaptic vesicle protein 2A. Levetiracetam is generally well tolerated. Common side effects of levetiracetam include lethargy, drowsiness, headaches, and mood changes. Rhabdomyolysis and an increase in Creatine Kinase (CK) levels are one of the rarely reported effects of levetiracetam. Case presentation: We present a case of a 20-year-old patient with previously known epilepsy (non-compliant with medicine) who presented with a seizure. The patient was given 1 gram of levetiracetam in the emergency department and was kept at a maintenance dose of 500 mg twice a day. The workup revealed acute kidney injury and raised levels of creatinine kinase that peaked at 19,757 IU/L 72 hours after levetiracetam was started. Levetiracetam was later switched to lamotrigine and aggressive intravenous hydration was done. Gradual improvement of CK level was noted accompanied by improvement in renal function. Conclusion: Only a few cases of levetiracetam-induced rhabdomyolysis have been reported worldwide. Our case report highlights the importance of monitoring creatinine and CK levels while treating patients with levetiracetam as rhabdomyolysis can be asymptomatic with a rise in CK levels only.

Pregabalin-induced rhabdomyolysis: a case series and literature analysis.

Pregabalin is a prescription medicine that has recently been approved for individuals who suffer from fibromyalgia, neuropathic pain, anxiety disorder, or epilepsy. Pregabalin has the side effects of dizziness, sleepiness, and angioedema. Pregabalin-induced rhabdomyolysis has been rarely reported, with only four reports to date. We report two cases of rhabdomyolysis after pregabalin treatment. A man aged older than 90 years presented with exhaustion, muscle aches, and a high serum creatine kinase concentration after taking 75 mg of pregabalin on the first day of treatment. A woman in her 90s with long-term use of pregabalin presented with considerably elevated serum creatine kinase concentrations. Both patients had a long history of taking statins. Pregabalin therapy was stopped, high-volume intravenous fluids were administered, and serum electrolytes were frequently checked. Alkalinisation was performed with excellent outcomes. The Naranjo Adverse Drug Reaction scale and previous research suggest an association between pregabalin and rhabdomyolysis. Clinicians should be alert to the possibility of rhabdomyolysis occurring with the use of pregabalin, especially when taking statins.

Surveillance for rhabdomyolysis after the consumption of crayfish in Wuhan, China, 2016-2022.

To analyze the epidemiological characteristics and etiology of crayfish-related rhabdomyolysis. Cases of crayfish-related rhabdomyolysis in Wuhan were monitored, and professional training of city's surveillance personnel was conducted. Unified questionnaires were used to collect data. The first case of crayfish-related rhabdomyolysis occurred on July 12, 2016. Subsequently, 423 patients were reported over the next 7 years, with muscle pain, weakness, and chest distress as main symptoms. In total, 64.54% (273/423) of patients were females, and young adults (aged 20-49 years) account for 86.22% (363/423) of patients. The primary clinical presentations were muscle pain, muscle weakness, and chest discomfort. The median incubation time was 6 h. And the number of cases may be related to water levels in Yangzi river. Laboratory tests revealed elevated creatine kinase and myoglobin levels. In total, 95.16% (236/248) of patients had consumed crayfish tail shrimp and 91.53% (227/248) had consumed crayfish liver and pancreas (Female crayfish also contain ovaries). Only 25.00% (62/248) of patients had a history of alcohol consumption. On average, 227 patients consumed 15 (3-50) crayfish, of whom 84.14% (191/227) consumed more than 10 crayfish. All patients had a favorable prognosis. Crayfish-related rhabdomyolysis is a kind of a case or cluster of patients present with severe myalgia or weakness of unknown etiology and mechanism disease in Wuhan, China, 2016-2022. Excessive consumption of crayfish may be a risk factor for the disease. The relationship between the specific parts of crayfish consumed and the onset of the disease is unclear, suggesting further research is needed to identify the relevant risk factors for the disease.

Clinical case of mechanical and non-mechanical rhabdomyolysis complicated by acute kidney injury. Case report

To date, the problem of rhabdomyolysis remains relevant in Russia. Despite the introduction of modern methods of diagnosis, prevention and treatment, mortality remains high, up to 40%, especially with the addition of acute kidney injury. This article presents a clinical case of rhabdomyolysis, which arose as a result of the combined effects of non-traumatic (toxic effects of methadone, alcohol) and traumatic (vibration and non-physiological position during sleep) factors. This syndrome eventually led to the development of acute kidney damage up to anuria. In this clinical case, intensive infusion and detoxification therapy, including hemodialysis procedures, was carried out, which led to an almost complete restoration of the functional state of the kidneys. Thus, early diagnosis of rhabdomyolysis and AKI based on anamnesis, timely laboratory and instrumental diagnosis can prevent severe kidney damage up to terminal uremia and fatal consequences.

170 Dance Until You Drop: A Case of Ecstasy-associated Rhabdomyolysis

170 Dance Until You Drop: A Case of Ecstasy-associated Rhabdomyolysis

Myalgia‐induced discovery of rhabdomyolysis complicating generalized varicella in an immunocompetent patient: Case report and review of the literature

Key clinical messageIn a rare occurrence, primary varicella infection led to rhabdomyolysis in a 24‐year‐old with no medical history. Presenting with rash, fever, and weakness, he developed diffuse myalgia at 72 h. Elevated muscle enzymes confirmed rhabdomyolysis secondary to varicella zoster virus (VZV) infection. Treatment with acyclovir and hydration resulted in significant improvement within a month.AbstractPrimary varicella infection is rarely complicated by rhabdomyolysis. In this study, we describe a case of rhabdomyolysis complicating a VZV infection in a black subject. The patient was a 24‐year‐old black African with no particular medical history and was immunocompetent. He presented with an acute onset of generalized rash, fever, and generalized weakness. Physical examination revealed vesicular lesions typical of chickenpox. Antipyretic treatment combined with acyclovir was instituted in hospital. At the 72nd hour, diffuse myalgia developed. Muscle enzyme tests revealed CPK elevated to 40 times the upper limit of normal, LDH elevated to 2 times the upper limit of normal, ASAT and ALAT elevated to 7 times the upper limit of normal, and 2.5 times the upper limit of normal, respectively. We accepted the diagnosis of rhabdomyolysis secondary to VZV infection. The patient was given saline hydration and showed clinical and biological improvement 1 month later. A patient presenting with muscular symptoms during a VZV infection should be considered for rhabdomyolysis.

Venlafaxine-Associated Rhabdomyolysis: A Literature Review.

This systematic review aimed to investigate the clinical manifestations and characteristics of venlafaxine-associated rhabdomyolysis. A systematic search was conducted in PubMed, Elsevier, Science Direct, Embase, Springer Link, Wiley Online Library, CNKI, and Wanfang databases from the date of database inception to January 2023. Previously reported cases of venlafaxine-associated rhabdomyolysis were identified, and relevant data from these cases were collected for descriptive statistical analysis. Cases that met the inclusion criteria were evaluated to determine the correlation between adverse reactions and venlafaxine. A total of 12 patients with venlafaxine-associated rhabdomyolysis were included. None of these patients had a history of muscle pain or discomfort. Of the 12 patients, 5 patients received venlafaxine at doses of ≤225 mg/d, whereas the remaining 7 patients received doses exceeding 225 mg/d. The main clinical symptoms included myalgia, muscle weakness, and renal injury. All 12 patients discontinued venlafaxine and received symptomatic care. Venlafaxine, used either as a monotherapy or in combination with other drugs, may be associated with rhabdomyolysis. Creatine kinase levels may normalize or significantly decrease after discontinuation of venlafaxine and symptomatic treatment.

Incidence, characteristics, and risk factors of drug-associated muscle adverse reaction: a retrospective real-world study of inpatients.

To analyze the clinical characteristics, incidence, and distribution of drug-associated muscle adverse reactions (DAMAR) in real-world inpatients, to provide valuable references for clinical medication use. We conducted an automatic retrospective monitoring of inpatients from May 1, 2022, to April 30, 2023, to collect information on adverse drug reactions (ADR) of patients and conducted subsequent analyses. Among 102,430 hospitalizations, 1106 cases of DAMARs were identified, yielding an incidence of 1.08%, including 125 cases of rhabdomyolysis at an incidence of 0.12%. Seventy-five percent of the patients experienced muscle adverse reactions within 5 days after taking medication, with a median elevated creatine kinase (CK) value of 420.4 IU/L. Risk factors of DAMAR include age ≥ 65, male sex, obesity, hypertension, hepatic and renal insufficiency, and anemia. No significant correlation was observed between the duration of surgery and CK elevation, while the surgical procedure itself had an impact. The 114 drugs associated were predominantly nervous system drugs, anti-infectives for systemic use, and cardiovascular system drugs, with levofloxacin, pregabalin, and parecoxib being the most frequently associated drugs. Healthcare professionals should be vigilant with patients exhibiting the identified risk factors. Monitoring creatine kinase and related indices when using myotoxic drugs is crucial to preventing serious adverse reactions, ultimately preserving patients' quality of life.

Statin Associated Muscular Adverse Effects.

Statins are widely used in the treatment of hyperlipidemia and in the prevention of cardiovascular diseases. However, they may induce muscular adverse effects that range from asymptomatic elevation of creatine kinase to life threatening rhabdomyolysis. The aim of the study was to describe epidemiological and clinical characteristics of patients with muscular adverse effects. We conducted a retrospective and descriptive study over a ten-year period from January 2010 to December 2019. We included all cases of statin associated muscular adverse effects notified to the Tunisian National Centre of Pharmacovigilance during this period. The study involved 22 muscular adverse effects related to statins (28% of all adverse events reported with statins during this period). Patient's mean age was 58.7 years and the sex ratio was 1.6. There were 12 cases of isolated creatine kinase elevation, 5 cases of myalgia, 3 cases of myopathy, one case of myositis and one case of rhabdomyolysis. Muscular adverse effects occurred 7 days to 15 years after starting this drug. In all cases, the statin was withdrawn after muscular adverse effects and resolution of symptoms was observed within 10 days to 18 months. In seven cases, creatine kinase persisted elevated for 18 months. Involved statins were atorvastatin, simvastatin, rosuvastatin and fluvastatin. Early recognition of muscle symptoms is required to prevent rhabdomyolysis. Further researchare needed to completely elucidate the pathophysiology of statin-induced muscular adverse effects.

Levodopa-Entacapone-Carbidopa Intestinal Gel Treatment in Advanced Parkinson's Disease: A Single-Center Study of 30 Patients.

Levodopa-entacapone-carbidopa intestinal gel (LECIG) is a novel device assisted treatment option for advanced Parkinson's disease (PD). It has been available in Finland since 2020. There is paucity of scientific studies considering LECIG treatment in clinical practice. Objectives of this study were to evaluate the changes in medication, adverse events and early discontinuations of LECIG treatment in real life clinical practice. The records of 30 consecutive patients, who received LECIG between years 2020 and 2022 in Helsinki University Hospital, were retrospectively analyzed. Data considering changes in medication, discontinuations, and adverse events during the first six months of LECIG treatment was collected. Mean levodopa equivalent daily dose (LEDD) rose significantly between baseline before LECIG and six months with treatment (1230 mg vs. 1570 mg, P = 0.001). Three patients were discarded during nasojejunal tube test phase and seven discontinued the treatment during six-month follow-up. Most common reasons for discontinuation were difficulty in finding suitable infusion rate and neuropsychiatric problems. Safety issues encountered were similar to those reported with levodopa-carbidopa intestinal gel (LCIG) treatment. One case of rhabdomyolysis due to severe dyskinesia during LECIG treatment was observed. Patients were satisfied with the small size of the pump system. LEDD seems to increase during the first months of LECIG treatment. When compared to studies on LCIG, safety profile of LECIG appears similar, but early discontinuation rate is higher than expected. However, long-term studies are lacking. Only clear advantage to LCIG appears to be the smaller LECIG pump size.

A Case of Rhabdomyolysis and Acute Tubular Necrosis with Lower than Expected Creatinine Kinase Level in a Patient with Cocaine Abuse

A Case of Rhabdomyolysis and Acute Tubular Necrosis with Lower than Expected Creatinine Kinase Level in a Patient with Cocaine Abuse

A Case of Terbinafine-Associated Rhabdomyolysis and Drug-Induced Liver Injury (DILI) That Progressed to Acute Renal and Liver Failure

A Case of Terbinafine-Associated Rhabdomyolysis and Drug-Induced Liver Injury (DILI) That Progressed to Acute Renal and Liver Failure

Renal Salt Wasting: Earliest Manifestation of Rhabdomyolysis, Supreet/Mehandru Syndrome

Acute kidney injury is a feared and common complication of rhabdomyolysis, occurring in 10-40% of hospitalized patients with mortality rate as high as 59% in critically ill patients. However, there is a lack of information in the literature on renal salt wasting in rhabdomyolysis. We report 3 cases of rhabdomyolysis who developed renal salt wasting in presence of normal glomerular filtration rate. To the best of our knowledge, this is the first case report in humans displaying this phenomenon. Authors noted that all the three patients had urine pH of over 7.0. Literature reveals, patients with rhabdomyolysis and urine pH<6.5 develop acute kidney injury whereas urine pH>7.0 experienced renal salt wasting in presence of normal glomerular filtration rate. All 3 cases, previously not known to have hypertension, were noted to have elevated blood pressure during acute phase of rhabdomyolysis. Animal studies have shown that increase in blood pressure causes increase in renal interstitial pressures that results in naturesis and diuresis. All 3 cases had increased levels of plasma renin activity and aldosterone. There is a direct proportionality between increased blood pressure and naturesis. Clinicians should be aware of salt wasting as an early renal manifestation in patients with rhabdomyolysis

Rhabdomyolysis or Severe Acute Hepatitis Associated with the Use of Red Yeast Rice Extracts: an Update from the Adverse Event Reporting Systems.

Elevated plasma levels of low-density lipoprotein cholesterol (LDL-C) are a major risk factor for atherosclerotic cardiovascular disease (ASCVD), and lowering LDL-C reduces the risk of cardiovascular adverse events. Among natural approaches known for their lipid-lowering properties, red yeast rice (RYR) has a cholesterol-lowering effect due to the presence of bioactive components (monacolins) that act by inhibiting the activity of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. In August 2018, the European Food Safety Authority (EFSA) concluded in its assessment of the use of RYR (further amended in June 2022) that monacolins from RYR raise significant safety concerns when used as a food supplement at a dose of 10 mg/day. In particular, individual cases of serious adverse effects of monacolins from RYR have been reported at intakes as low as 3 mg/day. The EFSA Panel pointed out several uncertainties regarding the available data. We conducted an in-depth and updated analysis of the serious adverse events, with a focus on rhabdomyolysis and acute hepatitis, associated with the consumption of RYR. An analysis of the Food and Drug Administration reporting systems revealed a very small number of cases of rhabdomyolysis or severe acute hepatitis associated with RYR use. In addition, only a few case reports of these serious adverse events associated with RYR use have been published. Based on data from adverse event reporting systems and available case reports, the occurrence of rhabdomyolysis or severe acute hepatitis that could be associated with the use of RYR appears to be extremely rare compared to the occurrence with statins, which is rare to common.

A Case of Relugolix-Associated Rhabdomyolysis

A Case of Relugolix-Associated Rhabdomyolysis