clozapine and Hematuria

This report describes a 48-year-old caucasian male with schizophrenia who developed hepatitis, hyperglycemia, pleural effusion, eosinophilia, hematuria and proteinuria early in clozapine treatment which resolved on drug discontinuation. The literature on similar cases is reviewed.

Topics: Antipsychotic Agents; Blood Cell Count; Chemical and Drug Induced Liver Injury; Clozapine; Eosinophilia; Hematuria; Humans; Hyperglycemia; Male; Middle Aged; Pleural Effusion; Proteinuria; Schizophrenia, Paranoid; Tomography, X-Ray Computed

In case I, a 31-year-old man who had undergone unusual high-performance training, painful swellings occurred in the left arm and creatine kinase activity was raised (28,644 U/l), as well as that of the transaminases. A rapid urine test for blood was positive, but the sediment was free of red blood cells. There were no other pathological findings. Fluid intake was increased to 31 daily and on the third day he was symptom-free and creatine kinase activity had fallen to 6475 U/l, reaching normal values on the 15th day. Case 2 concerned a 28-year-old woman with paranoid schizophrenia who had taken several tablets of clozapine and then remained in bed for 3 days. She complained of pain in the region of the gluteus maximus muscles, exacerbated on pressure but otherwise unremarkable. Creatine kinase was raised to 21,492 U/l, creatine to 186 mumol/l, and the transaminases were likewise increased. The urine strip-test for blood was twice positive. She was treated with frusemide (80 mg daily) and infusions of electrolyte solution (21 daily). She became pain-free on the second day and the various enzyme activities rapidly fell to normal.

Topics: Adult; Clozapine; Combined Modality Therapy; Creatine Kinase; Drug Overdose; Exercise; Female; Fluid Therapy; Furosemide; Hematuria; Humans; Male; Physical Education and Training; Rhabdomyolysis; Schizophrenia, Paranoid