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      Nontraumatic rhabdomyolysis with short-term alcohol intoxication – a case report

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          Key Clinical Message

          Alcohol-induced rhabdomyolysis is a potentially life-threatening condition due to the probability of progression to acute renal injury. Patients admitted to emergency department with acute alcohol intoxication should always undergo blood and urine tests for early recognition and treatment of rhabdomyolysis.

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          Rhabdomyolysis: review of the literature.

          Klaas van Gisbergen, R Wanders, Astrid Linthorst … (2014)
          Rhabdomyolysis is a serious and potentially life threatening condition. Although consensus criteria for rhabdomyolysis is lacking, a reasonable definition is elevation of serum creatine kinase activity of at least 10 times the upper limit of normal followed by a rapid decrease of the sCK level to (near) normal values. The clinical presentation can vary widely, classical features are myalgia, weakness and pigmenturia. However, this classic triad is seen in less than 10% of patients. Acute renal failure due to acute tubular necrosis as a result of mechanical obstruction by myoglobin is the most common complication, in particular if sCK is >16.000 IU/l, which may be as high as 100,000 IU/l. Mortality rate is approximately 10% and significantly higher in patients with acute renal failure. Timely recognition of rhabdomyolysis is key for treatment. In the acute phase, treatment should be aimed at preserving renal function, resolving compartment syndrome, restoring metabolic derangements, and volume replacement. Most patients experience only one episode of rhabdomyolysis, mostly by substance abuse, medication, trauma or epileptic seizures. In case of recurrent rhabdomyolysis, a history of exercise intolerance or a positive family history for neuromuscular disorders, further investigations are needed to identify the underlying, often genetic, disorder. We propose a diagnostic algorithm for use in clinical practice. Copyright © 2014 Elsevier B.V. All rights reserved.
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            Rhabdomyolysis.

            Janice Zimmerman, Michael C Shen (2013)
            Rhabdomyolysis is a well-known clinical syndrome of muscle injury associated with myoglobinuria, electrolyte abnormalities, and often acute kidney injury (AKI). The pathophysiology involves injury to the myocyte membrane and/or altered energy production that results in increased intracellular calcium concentrations and initiation of destructive processes. Myoglobin has been identified as the primary muscle constituent contributing to renal damage in rhabdomyolysis. Although rhabdomyolysis was first described with crush injuries and trauma, more common causes in hospitalized patients at present include prescription and over-the-counter medications, alcohol, and illicit drugs. The diagnosis is confirmed by elevated creatine kinase levels, but additional testing is needed to evaluate for potential causes, electrolyte abnormalities, and AKI. Treatment is aimed at discontinuation of further skeletal muscle damage, prevention of acute renal failure, and rapid identification of potentially life-threatening complications. Review of existing published data reveals a lack of high-quality evidence to support many interventions that are often recommended for treating rhabdomyolysis. Early and aggressive fluid resuscitation to restore renal perfusion and increase urine flow is agreed on as the main intervention for preventing and treating AKI. There is little evidence other than from animal studies, retrospective observational studies, and case series to support the routine use of bicarbonate-containing fluids, mannitol, and loop diuretics. Hyperkalemia and compartment syndrome are additional complications of rhabdomyolysis that must be treated effectively. A definite need exists for well-designed prospective studies to determine the optimal management of rhabdomyolysis.
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              Rhabdomyolysis.

              G N Marinides, K. Wang, John Sauret (2002)
              Rhabdomyolysis is a potentially life-threatening syndrome resulting from the breakdown of skeletal muscle fibers with leakage of muscle contents into the circulation. The most common causes are crush injury, overexertion, alcohol abuse and certain medicines and toxic substances. Several inherited genetic disorders, such as McArdle's disease and Duchenne's muscular dystrophy, are predisposing factors for the syndrome. Clinical features are often nonspecific, and tea-colored urine is usually the first clue to the presence of rhabdomyolysis. Screening may be performed with a urine dipstick in combination with urine microscopy. A positive urine myoglobin test provides supportive evidence. Multiple complications can occur and are classified as early or late. Early complications include severe hyperkalemia that causes cardiac arrhythmia and arrest. The most serious late complication is acute renal failure, which occurs in approximately 15 percent of patients with the syndrome. Early recognition of rhabdomyolysis and prompt management of complications are crucial to a successful outcome.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Case Rep
                Journal ID (iso-abbrev): Clin Case Rep
                Journal ID (publisher-id): ccr3
                Title: Clinical Case Reports
                Publisher: John Wiley & Sons, Ltd (Chichester, UK )
                ISSN (Print): 2050-0904
                ISSN (Electronic): 2050-0904
                Publication date (Print): October 2015
                Publication date (Electronic): 20 August 2015
                Volume: 3
                Issue: 10
                Pages: 769-772
                Affiliations
                [1 ]Department of Internal Medicine, General Hospital of Trikala Trikala, Greece
                [2 ]Department of Internal Medicine, General Hospital of Athens “Elpis” Athens, Greece
                [3 ]Department of Otorhinolaryngology, University of Patras, Medical School Patras, Greece
                Author notes
                Correspondence George Bazoukis, Department of Internal Medicine, General Hospital of Athens “Elpis”, Dimitsanas 7, Ambelokipi, 11522 Athens, Greece. Tel: +306983241394; Fax: +302106426331; E-mail: gbazoykis@ 123456med.uoa.gr

                Funding Information: No sources of funding were declared for this study.

                Article
                DOI: 10.1002/ccr3.326
                PMC ID: 4614635
                PubMed ID: 26509002
                SO-VID: fea600d6-81e1-4213-a03b-7f86047a9067
                Copyright © © 2015 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                Date received : 14 December 2014
                Date revision received : 11 May 2015
                Date accepted : 10 June 2015
                Categories
                Subject: Case Reports

                Keywords: alcohol intoxication,alcohol-induced rhabdomyolysis,nontraumatic rhabdomyolysis,rhabdomyolysis
                Data availability:
                Keywords: alcohol intoxication, alcohol-induced rhabdomyolysis, nontraumatic rhabdomyolysis, rhabdomyolysis

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