Rhabdomyolysis: An Evaluation Of 56 Hospitalized Intoxicated Patients

Rhabdomyolysis results from acute muscle fibers necrosis with leakage of muscleconstituents into blood. It is a common and potentially lethal clinical syndrome. Acute renalfailure (ARF) which appears in 15%-33% of patients with rhabdomyolysis is due to theMyoglobinuria. Intoxications, inherited diseases, muscle compression or overexertion, orinflammatory processes, are among other disorders cause rhabdomyolysis. No cause is found insome cases. To determine the most common etiologic factors underlying development ofrhabdomyolysis and related complications in poisoned patients the present study was carried out.Material: We describe 56 patients who were hospitalized in toxicology ICU of "LoghmanHakim Hospital", the biggest toxicology unit in the world, between February 2002 and March2003. Of 813 patients, 56 patients with an acute overdose and serum creatine kinase (CK) morethan 5 times the upper limit of normal (>975 IU/L) were included. Patients with recentmyocardial infarction or stroke were excluded. For all, the highest values of serum CK, serumcreatinine, and urine hemoglobin, and red blood cells were recorded. Of the 56 patients, 5 were female and 51 were male (median age, 32 yr; range, 16-76yr).The most common intoxication responsible for rhabdomyolysis, included opium(42.5%),tricyclic antidepressants(19.5%), and benzodiazepines(9%). In 5%, no cause was found. Acuterenal failure (ARF) was present in 16 (29%) patients, of whom 15 were male. Five male subjectswith ARF required hemodialysis which all of them died (9%). Hemodialysed ARF had asignificant correlation with death. Urine dipstick for heme was positive in 96.5%. Patients using illicit drugs were at risk for rhabdomyolysis. With appropriate carefor prevention of ARF, death is rare.