Case Of Rhabdomyolysis Research Articles

Rhabdomyolysis associated with single-dose intravenous esomeprazole administration

Background:Proton pump inhibitors are usually safe, although serious adverse effects can occur. We report the first case of rhabdomyolysis associated with single-dose intravenous esomeprozole administration.Methods:A 45-year-old Korean male visited our emergency room because of persistent lower chest discomfort that started 10 hours before. He had been diagnosed with diabetes and coronary heart disease, but discontinued oral hypoglycemic agents 1 month earlier. He continued to take medications for coronary heart disease. There was no abnormality on an electrocardiogram or in cardiac enzymes. Initial laboratory findings did not show abnormalities for muscle enzymes. Esomeprozole 40 mg was administrated intravenously for the control of his ambiguous chest discomfort. Then, 12 hours later, he complained of abrupt severe right buttock pain. An area of tender muscle swelling 8 cm in diameter was seen on his right buttock area. Creatine kinase and lactate dehydrogenase were elevated to 40,538 and 1326 U/L, respectively. A bone scan using 20 mCi of 99mTc-hydroxymethylene diphosphonate was compatible with rhabdomyolysis.Results:His muscular symptoms, signs, and laboratory findings improved markedly with conservative management, including hydration and urine alkalinization. He is being followed in the outpatient department with no evidence of recurrence.Conclusion:We should keep in mind that single-dose intravenous administration of esomeprazole can induce rhabdomyolysis.

Desoxypipradrol – eine neue (alte) Designerdroge

Novel psychoactive substances (NPS) are easily accessible and the consumption has increased in recent years. New compounds as well as compounds derived from pharmaceutical research or the patent literature are provided, mostly without any declaration. As a consequence, severe adverse reactions may occur after consumption of unknown doses of these drugs, in particular after mixed intake of different psychoactive substances or co-medication. The toxic effects in such cases are not predictable. We report cases of rhabdomyolysis in patients after consumption of desoxipipradrol in combination with other NPS. Particularly in case of synergistic serotonergic effects a distinct stimulation of 5-HT2A-receptors (or 5-HT1A-receptors) should be considered which may lead to serotonergic syndrome.

Efficacy and safety of fenofibrate as an add-on in patients with elevated triglyceride despite receiving statin treatment

BackgroundSince the withdrawal of cerivastatin, statin–fibrate combination therapy has been questioned in China due to safety concern. The objective of this study was to evaluate the efficacy and safety profile of fenofibrate as an add-on in patients with dyslipidemia despite receiving statin therapy. MethodsThis was a prospective, multi-center, single-arm, open-label study conducted in Chinese dyslipidemia patients with high CV risk. Fenofibrate (200mg daily) was added to the existing statin treatment for 8weeks. Lipid profile and safety parameters were measured and compared between baseline and after the treatment. Five hundred and six subjects were enrolled from 28 sites from 14 cities nationwide across China. ResultsAfter 8weeks of fenofibrate treatment, the mean blood triglyceride level decreased to 1.77mmol/L (38.1% reduction vs. 3.00mmol/L at the baseline; p<0.01). Mean high-density lipoprotein cholesterol (high density lipoprotein cholesterol) was increased to 1.22mmol/L (by 17.4% from 1.07mmol/L at the baseline; p<0.01). No case of severe muscle damage (defined as elevated creatine kinase over 5 times of upper limit of normal (ULN) or rhabdomyolysis was observed. ConclusionIn statin-treated patients with high CV risk who had elevated triglyceride, adding fenofibrate could improve lipid profile with acceptable safety profiles.

Rhabdomyolysis case based on hypothyroidism

Rhabdomyolysis case based on hypothyroidism

A rare autopsy case of traumatic rhabdomyolysis associated with intermittent assault

Traumatic rhabdomyolysis generally occurs after severe blunt trauma and is acute in onset, associated with severe disease, and potentially lethal. Accordingly, diagnosis of traumatic rhabdomyolysis in patients without massive subcutaneous or intramuscular hemorrhage is difficult, especially in the postmortem period, which is limited in terms of the availability of biochemical examination tools and accurate history of illness. To the best of our knowledge, there are no previous reports of death from traumatic rhabdomyolysis among individuals who did not pursue medical consultation. A previously healthy man in his early sixties had been punched and kicked several times in the previous 2months, but he had not gone to a hospital. He suddenly lost consciousness at his workplace approximately 5days after the most recent assault, and cardiopulmonary arrest occurred when the emergency service arrived. He died the same day, and a medicolegal autopsy was performed. Although several sites of minor subcutaneous and muscle hemorrhage were observed, the cause of death was unclear upon macroscopic assessment. Immunohistochemical staining revealed acute renal failure caused by rhabdomyolysis. We herein report a rare case of fatal traumatic rhabdomyolysis, seemingly associated with minor and apparently nonlethal muscle injury.

Severe rhabdomyolysis from red-bellied black snake (Pseudechis porphyriacus) envenoming despite antivenom

Envenoming by the Australian red-bellied black snake (Pseudechis porphyriacus) causes non-specific systemic symptoms, anticoagulant coagulopathy, myotoxicity and local effects. Current management for systemic envenoming includes administration of one vial of tiger snake antivenom within 6 h of the bite to prevent myotoxicity. We present a case of severe rhabdomyolysis in a 16 year old male which developed despite early administration of one vial of tiger snake antivenom. Free venom was detected after the administration of antivenom concurrent with rapidly decreasing antivenom concentrations. The case suggests that insufficient antivenom was administered and the use of larger doses of antivenom need to be explored for red-bellied black snake envenoming.

Nefrotik Sendromlu Hastada Statin Tedavisine Bağlı Rabdomiyoliz ve Trombositopeni Birlikteliği

Hyperlipidemia is a component of the nephrotic syndrome and should be treated for increased risk of cardiovascular diseases. Statins are first choice in treatment. However, gastrointestinal side effects are commonly seen in patients with statin therapy. A 73-year-old man who used statin therapy for hyperlipidemia due to nephrotic syndrome presented to our clinic with muscle weakness and rhabdomyolysis and thrombocytopenia was detected. The patient’s complaints improved after discontinuation of statin therapy. We report the case of thrombocytopenia and rhabdomyolysis associated with statin therapy in this patient, as it is a rare entity. kEY wORDs: Statin, Rhabdomyolysis, Thrombocytopenia

Hemodiyaliz ile Sekelsiz Tedavi Edilen Ağır Hipernatremi ve Rabdomiyoliz Olgusu

Hemodiyaliz ile Sekelsiz Tedavi Edilen Ağır Hipernatremi ve Rabdomiyoliz Olgusu

Komur á bráðamóttöku Landspítala vegna áreynslurákvöðvarofs árin 2008-2012

Introduction: Overexertion and too much training are among the ­multiple etiologies of rhabdomyolysis. Creatine kinase (CK) and myo­globine, released from skeletal muscle cells, are useful for diagnosis and follow-up. Acute kidney injury is a serious complication of myoglobinemia. Literature on exertional rhabdomyolysis in the general population is scarce. The aim of this study was to investigate the epidemiology of exertional rhabdomyolysis among patients diagnosed at Landspítali The National University Hospital of Iceland in 2008-2012. Materials and methods: The study was retrospective and observational. All patients presenting with muscle pain after exertion and elevated creatine kinase &gt;1000 IU/L, during the period from 1 January 2008 to 31 December 2012, were included. Patients with CK elevations secondary to causes other than exertion were excluded. Variables included: patient number and gender, CK-levels, date of hospital admission, cause of rhabdomyolysis, location of injured muscle groups, length of hospital stay, complications and means of fluid replacement. Population figures of the capital region were gathered from Statistics Iceland and information on sport practice in the capital region from The National Olympic and Sports Association of Iceland. Results: Exertional rhabdomyolysis was diagnosed in 54 patients, 18 females (33,3%) and 36 males (66,7%), or 8,3% of rhabdomyolysis cases from all causes in the study period (648 cases). Incidence in the capital region was 5,0/100.000 inhabitants per year in the study period. Median age was 28 years and median CK-level was 24.132 IU/L. CK-levels were higher among females but the difference between genders was not significant. Muscle groups of the upper and lower extremities were most frequently affected (89%). Thirty patients received intravenous fluids. They had significantly higher CK values than other patients. One patient developed acute kidney injury. Information on sport practice and physical training in the capital region was not available. Conclusion: Exertional rhabdomyolysis is uncommon but mostly affects younger people. Information on the practice of exertion among males and females is not available but CK-levels were not significantly different between genders, age groups or different muscle groups. CK-levels were high but complications uncommon. Studies of exertional rhabdomyolysis in the general population are lacking.

Acute Renal Failure Secondary to Rhabdomyolysis as a Complication of Major Urological Surgery: The Experience of a High-Volume Urological Center

Objective: The aim of this study was to determine the incidence of acute renal failure secondary to rhabdomyolysis (ARFSR) as a complication of major urological surgery (MUS), as well as to describe the clinical characteristics and identify possible risk and protective factors. Subjects and Methods: Cases of ARFSR due to MUS between January 1997 and August 2011 were identified using the institutional database. The incidence was estimated and the clinical characteristics were analyzed using simple scatterplot graphs to identify possible risk and protective factors. Results: In this period, 14,337 MUS procedures were performed, in which 4 cases suffered from ARFSR (the incidence rate was 0.03%). The incidence rates after radical cystectomy and urethroplasty were 0.26% (3/1,175 cases) and 0.15% (1/651 cases), respectively. No case of rhabdomyolysis was reported among the patients who underwent other major surgical procedures. Two patients required dialysis, and all 4 patients recovered to their baseline renal function at an average of 11 days (7-17) with the appropriate treatment. Male gender, younger age, lower ASA score, prolonged operative time, high body mass index, elevated preoperative serum creatinine and estimated blood loss were possible risk factors for developing ARFSR due to MUS. We found that a higher intraoperative administered volume was a possible protective factor. The operative position and type of surgery seemed to play minor roles. Early diagnosis and treatment possibly leads to an improved outcome. Conclusion: In our study, ARFSR due to MUS was a rare entity and had a good prognosis. It was more frequent as a complication of radical cystectomy. Further studies are required to confirm our findings.

Visits of patients with exertional rhabdomyolysis to the Emergency Department at Landspítali, The National University Hospital of Iceland in the years 2008-2012

Overexertion and too much training are among the -multiple etiologies of rhabdomyolysis. Creatine kinase (CK) and myo-globine, released from skeletal muscle cells, are useful for diagnosis and follow-up. Acute kidney injury is a serious complication of myoglobinemia. Literature on exertional rhabdomyolysis in the general population is scarce. The aim of this study was to investigate the epidemiology of exertional rhabdomyolysis among patients diagnosed at Landspítali The National University Hospital of Iceland in 2008-2012. The study was retrospective and observational. All patients presenting with muscle pain after exertion and elevated creatine kinase >1000 IU/L, during the period from 1 January 2008 to 31 December 2012, were included. Patients with CK elevations secondary to causes other than exertion were excluded. Variables included: patient number and gender, CK-levels, date of hospital admission, cause of rhabdomyolysis, location of injured muscle groups, length of hospital stay, complications and means of fluid replacement. Population figures of the capital region were gathered from Statistics Iceland and information on sport practice in the capital region from The National Olympic and Sports Association of Iceland. Exertional rhabdomyolysis was diagnosed in 54 patients, 18 females (33,3%) and 36 males (66,7%), or 8,3% of rhabdomyolysis cases from all causes in the study period (648 cases). Incidence in the capital region was 5,0/100.000 inhabitants per year in the study period. Median age was 28 years and median CK-level was 24.132 IU/L. CK-levels were higher among females but the difference between genders was not significant. Muscle groups of the upper and lower extremities were most frequently affected (89%). Thirty patients received intravenous fluids. They had significantly higher CK values than other patients. One patient developed acute kidney injury. Information on sport practice and physical training in the capital region was not available. Exertional rhabdomyolysis is uncommon but mostly affects younger people. Information on the practice of exertion among males and females is not available but CK-levels were not significantly different between genders, age groups or different muscle groups. CK-levels were high but complications uncommon. Studies of exertional rhabdomyolysis in the general population are lacking. Rhabdomyolysis, exertion, sports, physical training, CK elevation. Correspondence: Brynjolfur Mogensen, brynmog@landspitali.is.

Acute corticosteroid-induced rhabdomyolysis in a golf player

Acute corticosteroid-induced rhabdomyolysis is a rare, but potentially life-threatening, condition that deserves the attention of medical professionals and sport scientists. Early diagnosis is vital in minimising the secondary damage caused by rhabdomyolysis. This case of rhabdomyolysis highlights the severity of symptoms and the importance of decisive treatment. Clinicians should be familiar with the most common symptoms of acute corticosteroid-induced rhabdomyolysis to enable early diagnosis and efficient management of this condition.

Synthetic cannabinoid (“bonsai”) induced rhabdomyolysis; two case reports / Sentetik kannabinoid (“bonzai”) kullanımına bağlı rabdomiyoliz: İki olgu sunumu

Abstract Synthetic cannabinoid (SC) products are called “Spice” in Europe, “K2” in the United States and “Bonsai” in Turkey and sold under the counter. Widespread uses of these substances and lack of specific regulations about them cause serious problems. It is not very clear what these psychoactive products contain and how much and how often they can be given. Their metabolic effects are not known well either. There is not much known about the effects of SCs other than the ones on the neurological and cardiovascular systems. In this report, we presented two cases of rhabdomyolysis developing after bonsai consumption and requiring dialysis. Two bonsai users have been brought to our emergency department in an unconscious state. Their physical examinations were normal except tachicardia. Laboratory investigations revealed increased urea, serum creatinine, creatinine phosphokinase, lactate dehydrogenase and transaminase levels. The histories of the cases suggested that they had rhabdomyolysis due to cannabinoid use. A single session hemodialysis was performed for both cases. Their clinical appearance reached to stabilisation in the second hospital day and blood tests were normalised in one week. The patients were discharged at the end of the week with the normal laboratory results and psyciatric recommendations. These two cases underline the risk of rhabdomyolysis development, apart from well-known side effects of SCs.

Spontaneous Four Limb Compartment Syndrome

We present a unique case of atraumatic rhabdomyolysis and four-limb compartment syndrome. Edema and inflammation associated with rhabdomyolysis, was further exacerbated by aggressive saline resuscitation. This resulted in raised compartment pressures and necessitated four-limb fasciotomy. The cause of rhabdomyolysis was most likely multifactorial including systemic capillary leak syndrome seizure, illicit drug use (crack cocaine and methamphetamine) and the prescription medication, mirtazapine.

Molecular mechanisms of statin intolerance

Statins reduce cardiovascular morbidity and mortality in primary and secondary prevention. Despite their efficacy, many persons are unable to tolerate statins due to adverse events such as hepatotoxicity and myalgia/myopathy. In the case of most patients, it seems that mild-to-moderate abnormalities in liver and muscle enzymes are not serious adverse effects and do not outweigh the benefits of coronary heart disease risk reduction. The risk for mortality or permanent organ damage ascribed to statin use is very small and limited to cases of myopathy and rhabdomyolysis. Statin-induced muscle-related adverse events comprise a highly heterogeneous clinical disorder with numerous, complex etiologies and a variety of genetic backgrounds. Every patient who presents with statin-related side effects cannot undergo the type of exhaustive molecular characterization that would include all of these mechanisms. Frequently the only solution is to either discontinue statin therapy/reduce the dose or attempt intermittent dosing strategies at a low dose.

A series of cases of rhabdomyolysis after ingestion of Tricholoma equestre.

Tricholoma equestre (hereinafter – T. equestre) is a common edible fungus that is considered to be toxic under certain conditions. Here, we report four cases of acute poisoning caused by T. equestre, including one lethal outcome in Lithuania between 2004 and 2013. In the severe case, fatigue, nausea without vomiting and muscle pain, profuse sweating without fever, and respiratory insufficiency occurred. Laboratory tests showed an elevation of creatine kinase (CK), aspartate aminotransferase (AST), and alanine aminotransferase (ALT). Although clinical findings and laboratory tests support evidence of rhabdomyolysis, no renal insufficiency was observed. Significance of T. equestre in cardiac changes is feasible but remains unclear.

Rhabdomyolysis in Dak-Bum devotees: A case series.

Introduction:India is a land of culture and heritage always known for its rituals. The devotees offer their prayers in the form of fasting, sacrifices and many other difficult ways to please Almighty! While doing so they often endanger their lives. Rhabdomyolysis, in a particular group of devotees of Bihar/Jharkhand known as Dak-Bum, is a life-threatening clinical entity which occurs in these devotees who travel a long distance in a short period in a fasting state. Rhabdomyolysis detected by myoglobinuria can lead to acute kidney injury and mortality.Aim:To study and identify cases of rhabdomyolysis in devotees (Dak-Bum) and the role of early diagnosis and management.Materials and Methods:The study was conducted at Ruban Emergency Hospital Patna from August 2010 to August 2013 over 27 patients - 26 males and 1 female of age group 22–34 years. They presented with major symptoms such as dehydration, tender swollen calf muscles and myoglobinuria. The patients were admitted over a period of 2–3 weeks time in a single year (nine patients in 2010, five patients in 2011 and seven patients in 2012 and six patients in 2013). The study was restricted to the month of August every year, as this ritual occurs in a particular season. Inclusion criteria were all previously healthy devotees. The study period was from admission till discharge with daily follow-up of each patient.Results:Rhabdomyolysis developed in 27 Dak-Bum devotees and all had acute renal failure at the time of admission. RIFLE criteria-Stage F (failure) and acute kidney injury network criteria (3rd stage). However, recovery was good due to early intervention in the form of haemodialysis and forced alkaline diuresis by soda bicarbonate infusion.Conclusion:Rhabdomyolysis developing in Dak-Bum devotees because of travelling a long distance in a short period, could be managed well due of early diagnosis, timely referral, haemodialysis and forced alkaline diuresis.

C型慢性肝炎に対するダクラタスビル・アスナプレビル併用療法による横紋筋融解症の1例

症例は64歳の女性．C型慢性肝炎に対して2015年2月13日よりダクラタスビル・アスナプレビル併用療法を開始した．3月1日（治療開始後17日目）から発熱を認め，翌日には軽度のLDH上昇を呈していたが，慎重な観察のもと治療は継続された．しかしながら，3月5日（治療開始後21日目）に手足の脱力を訴え，血液検査において横紋筋融解症が疑われ精査加療目的にて入院となった．入院後，ダクラタスビル・アスナプレビル併用療法は速やかに中止され，横紋筋融解症に対する輸液による保存的治療が開始された．以後，血液検査所見および自覚症状は経時的に改善し退院となった．また，ダクラタスビル・アスナプレビル両剤中止にもかかわらずHCV RNAは治療終了後24週間の持続陰性を呈し，最終的にはSustained Virological Response（SVR）24に至った．

Hipotiroidiye Bağlı Rabdomiyoliz Olgusu

Hipotiroidiye Bağlı Rabdomiyoliz Olgusu

一例药品不良反应：横纹肌溶解的因果判断

一例药品不良反应：横纹肌溶解的因果判断