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Cocaine and Amphetamines
Published in Frank Lynn Iber, Alcohol and Drug Abuse as Encountered in Office Practice, 2020
A wide variety of medical and neurological complications have been described. Common ones include seizures, focal deficits, frank stroke, and vertigo.4 An interesting series of case reports of cocaine initiating migraine-like headache has appeared.5 The link between cocaine effects on serotonin uptake and the production of migraine is interesting.6 Acute myoglobinuria with renal insufficiency has been described a number of times.
Fever Of Unexplained Origin — Psychiatric Aspects
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Mortality approaches 14% in patients taking oral neuroleptics and 38% in those receiving long-acting depot agents. Clinical featues are hyperthermia, muscle rigidity, autonomic instability and fluctuating consciousness.30,33,34 Autonomic dysfunctions include pallor, diaphoresis, fluctuating blood pressure, tachycardia, and cardiac arrhythmias. Hyperthermia is a result of hypothalamic dysfunction and heat due to muscle rigidity; it may lead to death. Muscle rigidity described as “lead pipe”, may cause dyspnea, cyanosis and respiratory insufficiency. Prolonged muscle rigidity may also lead to myoglobinuria and renal failure.
Rhabdomyolysis
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
This patient's history is very concerning for exertional rhabdomyolysis. The creatine kinase (CK) is considered the defining biochemical marker with levels greater than four to five times the normal suggestive of this diagnosis. Myoglobinuria is also a diagnostic hallmark but results can be variable depending on sample timing due to its short serum half-life. The urine dipstick is positive for blood but there are <5 RBC/hpf microscopically. This makes the diagnosis of myoglobinuria more likely.
Serum creatine kinase levels are not associated with an increased need for continuous renal replacement therapy in patients with acute kidney injury following rhabdomyolysis
Published in Renal Failure, 2022
Liuniu Xiao, Xiao Ran, Yanxia Zhong, Yue Le, Shusheng Li
The myoglobin released from damaged muscles plays a dominant role in the pathogenesis ofRM–induced AKI [10]. Myoglobin is an iron-containing small protein with a molecular weight of 17.8 kDa and exists at a low concentration in serum under physiological conditions [11]. However, for a skeletal muscle injury, serum myoglobin levels increase within one hour and return to a normal range within one to six hours after lesion resolution. Myoglobin is freely filtered by the glomerulus and absorbed in the proximal tubule by endocytosis [12]. Excess myoglobin released into the circulation will lead to myoglobinuria and renal insufficiency, which brings about renal tubular obstruction and oxidative injury. A persistently increased serum creatinine, as well as a decreased glomerular filtration rate (eGFR), predicts deterioration of renal functions, resulting in AKI.
COVID-19 causing rhabdomyolysis requiring hemodialysis in a young adult
Published in Baylor University Medical Center Proceedings, 2022
Nitish Mittal, Gaspar Del Rio-Pertuz, Mostafa Abohelwa
SARS-CoV-2, the causative agent of COVID-19, continues to cause a worldwide pandemic. The most common symptoms are fever, myalgia, headache, dyspnea, and sore throat, with some patients presenting with end-organ failure and shock.1,2 In young adults, symptoms are likely milder; however, they can still develop severe symptoms. In mid-2020, the first cases of rhabdomyolysis causing myoglobinuria in post–COVID-19 patients were reported, and more cases have been reported since then.3 Rhabdomyolysis, a life-threatening disorder associated with myalgia, fatigue, and acute renal failure,4 is rare and was only reported in 0.2% of patients in a study of 1099 patients in China.5 It has been suggested that myoglobinuria occurs from an abnormal immune response to the virus. The inducing factors of rhabdomyolysis include autoimmune response, septicemia, electrolyte abnormalities, infection, and substance abuse.6 As time elapses, more cases will be studied to provide better understanding of post-COVID rhabdomyolysis and myoglobinuria.
A rare case of metapneumovirus-induced rhabdomyolysis and multi-organ dysfunction in a 4-year-old child
Published in Paediatrics and International Child Health, 2021
Aakash Chandran Chidambaram, Rohit Bhowmick, Narayanan Parameswaran, Dhandapany Gunasekaran
On Day 4 of admission, she developed multiple organ dysfunction syndrome (MODS) in the form of acute respiratory distress syndrome (ARDS) (Figure 1), acute kidney injury (creatinine progressively increased to 97.3 µmol/L) and coagulopathy (international normalised ratio 2.7). By Day 5, her urine was dark in colour and creatinine kinase (CK) levels (11,896 U/L) were rising markedly, suggestive of myoglobinuria (Figure 2). Urinary examination revealed a few RBC (3/mm3) and WBC (7/mm3), and biochemical examination demonstrated protein 1+ (on dipstick and 30% sulphosalicylic acid test) and myoglobin which confirmed the diagnosis of myoglobinuria. In view of the pigmentary nephropathy and worsening oliguria, continuous renal replacement therapy was initiated on Day 6. Haemophagocytic lymphohistiocytosis was ruled out as her blood counts, triglyceride, ferritin and fibrinogen were within normal limits [1] (Table 1). A detailed aetiological work-up was undertaken, including serology and polymerase chain reaction (PCR) for a variety of respiratory viruses (Table 2) which returned positive only for hMPV from a nasopharyngeal swab (tested positive by PCR). Other common tropical infections (scrub typhus, dengue, chikungunya, Leptospira) were ruled out by PCR and relevant serological tests. Repeated blood, sputum and urine cultures were sterile.