A person who abuses drugs or alcohol may develop rhabdomyolysis which can result in acute renal failure.


Abused substances associated with rhabdomyolysis:

(1) alcohol

(2) cocaine

(3) phencyclidine (PCP)

(4) heroin

(5) chemical contaminants in injected drugs

(6) any intravenously injected drug


Mechanism of skeletal muscle damage:

(1) trauma during intoxication (including physical assault)

(2) compartment syndrome

(3) intra-arterial injection with thrombosis and limb ischemia

(4) muscle compression while obtunded or comatose

(5) direct muscle toxicity

(6) recurrent seizures

(7) hypothermia

(8) cardiac arrest

(9) severe hyperthermia (especially with PCP)


Clinical findings:

(1) obtunded or comatose

(2) red-brown urine with oliguria

(3) muscle tenderness or swelling

(4) hypotension

(5) hyper- or hypothermia

(6) marked agitation

(7) recurrent seizures or status epilepticus

(8) evidence or history of drug and/or alcohol abuse

(9) compartment syndrome with neuropathy or limb ischemia

(10) elevated potassium and CK


Differential diagnosis:

(1) drug-induced nephropathy

(2) nephropathy related to concurrent infection

(3) interstitial nephritis


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