RHABDOMYOLYSIS: AN EVALUATION OF 56 HOSPITALIZED INTOXICATED PATIENTS

Background: Rhabdomyolysis results from acute muscle fibers necrosis with leakage of muscle constituents into blood. It is a common and potentially lethal clinical syndrome. Acute renal failure (ARF) which appears in 15%-33% of patients with rhabdomyolysis is due to the Myoglobinuria. Intoxications, inherited diseases, muscle compression or overexertion, or inflammatory processes, are among other disorders cause rhabdomyolysis. No cause is found in some cases. To determine the most common etiologic factors underlying development of rhabdomyolysis and related complications in poisoned patients the present study was carried out.Material: We describe 56 patients who were hospitalized in toxicology ICU of Loghman Hakim Hospital, the biggest toxicology unit in the world, between February 2002 and March 2003. Of 813 patients, 56 patients with an acute overdose and serum creatine kinase (CK) more than 5 times the upper limit of normal -( 975 IU/L) were included. Patients with recent myocardial infarction or stroke were excluded. For all, the-highest values of serum CK, serum creatinine, and urine hemoglobin, and red blood cells were recorded. Results: 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. Acute renal failure (ARF) was present in 16 (29%) patients, of whom 15 were male. Five male subjects with ARF required hemodialysis which all of them died (9%). Hemodialysed ARF had a significant correlation with death. Urine dipstick for heme was positive in 96.5%.Conclusion: Patients using illicit drugs were at risk for rhabdomyolysis. With appropriate care for prevention of ARF, death is rare.