heroin and Myoglobinuria

During acute intoxications rhabdomyolysis appear with a great clinical polymorphism. The muscular involvement is not always evident because of its shortness and latence. Practically the problem is one of localised muscle damage, hyperkaliema or acute renal insufficiency. The serum isoenzymes of CPK levels, the presence of myoglobinuria are necessary for the diagnosis. The most serious rhabdomyolysis depend on the added injury of respiratory muscles and myocardium. Many toxic substances can involve rhabdomyolysis but the most frequent ones are sedatives, carbonic oxyde, ethanol. Only the complications are treated.

Topics: Alcoholic Intoxication; Anesthesia, General; Animals; Carbon Monoxide Poisoning; Foodborne Diseases; Glycyrrhiza; Heroin; Humans; Hypnotics and Sedatives; Muscles; Myoglobinuria; Plants, Medicinal; Poisoning; Quail; Succinylcholine

Heroin abuse is an increasing problem in Australia. In our hospitals we have noted an apparent increase in drug-related admissions. In this study we aimed to examine the incidence of renal failure due to heroin-related rhabdomyolysis and to determine any predisposing factors to the requirement for dialysis in these patients.. We identified a group of 27 patients who developed renal failure after recent intravenous heroin use. There was a significant rise in the incidence during 1997-1998 compared with the previous seven years (p < 0.05).. Rhabdomyolysis was the likely cause of renal failure in all cases. Eight patients required dialysis for an average of 14 days (range 3-26). Patients who required dialysis had a higher admission creatine kinase (115 x 10(3) U/l (1-316), median (range), versus 9 x 10(3) (0-91 ), p < 0.05 ), a higher admission creatinine (3.8 mg/dl (2.1- 6.7) versus 2.4 (1.4-8.1), p < 0.05 ), a higher peak creatinine kinase (129 x 10(3) U/l (2-316) versus 22 x 10(3) (3-197), p < 0.05), a lower urine output in the initial 24 hours (0.91/24 hrs (0.1-1.5) versus 3.9(1.0-11.1), p < 0.005) and a longer length of hospitalization (37 days (17-112) versus 12 (5-87), p < 0.05). No patient died and all patients had independent renal function at last review. The majority of patients had significant comorbidities. The incidence of serological evidence of exposure to blood-borne viruses was HIV 5% (n = 1), hepatitis B 10% (n = 2) and hepatitis C 74% (n = 17) of patients tested. Pneumonia occurred in 52% (n = 14) and 26% (n = 7) developed respiratory failure requiring intubation. 22% (n = 6) developed a compartment syndrome requiring fasciotomy and 37% (n = 10) had significant residual limb weakness at discharge.. There is an increase in patients admitted with rhabdomyolysis-induced renal failure associated with heroin use in our hospitals. We found a varied approach to an increasing clinical problem and suggest that a consistent investigative and therapeutic approach be introduced. Although renal recovery can be expected, long-term disability may occur due to potential serious complications.

Topics: Acute Kidney Injury; Adult; Drug Overdose; Female; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Myoglobinuria; Prevalence; Retrospective Studies; Rhabdomyolysis; Substance Abuse, Intravenous

Topics: Acute Kidney Injury; Adult; Cocaine; Female; Heroin; Humans; Male; Myoglobinuria; Rhabdomyolysis; Substance-Related Disorders

Topics: Adult; Heroin; Humans; Illicit Drugs; Myoglobinuria; Rhabdomyolysis; Substance-Related Disorders

A 24-year-old man who had been a drug addict for years, was admitted to hospital having been unconscious for several hours after injecting an overdose of heroin. He was in acute renal failure with extensive swelling of soft tissues of the right upper leg and right buttock without external signs of injury. The swelling rapidly extended to both right limbs, trunk and external genitalia. The clinical suspicion of rhabdomyolysis was confirmed by a high level of serum myoglobin (1570 mg/ml), and in a gluteus maximus muscle biopsy. The acute renal failure caused by the rhabdomyolysis was reversible after a short period of haemodialysis and, after decompression fasciotomy of the affected muscles, there were no severe sequelae. In view of the good prognosis with early diagnosis an exact clinical examination (observation of soft tissue swelling and dark urine) is of great importance in case of heroin addiction and/or poisoning.

Topics: Acute Kidney Injury; Adult; Edema; Heroin; Heroin Dependence; Humans; Male; Myoglobin; Myoglobinuria

Topics: Adult; Heroin; Humans; Hypercalcemia; Kidney Papillary Necrosis; Male; Muscular Diseases; Myoglobinuria; Renal Dialysis; Substance-Related Disorders

Topics: Adult; Heroin; Humans; Illicit Drugs; Male; Methods; Myoglobinuria; Substance-Related Disorders

Heroin addiction is associated with several severe and occasionally fatal renal complications. Acute renal failure consequent to rhabdomyolysis and myoglobinuria, when treated supportively, carries a good prognosis. Staphylococcal or other bacterial septicemia may in itself prove fatal and is associated with a proliferative immune complex, acute glomerulonephritis, which generally follows the course and prognosis of septicemia. The necrotizing angiitis reported in heroin addicts still is largely undefined. Focal and segmental glomerular sclerosis is the most common pathologic finding in the syndrome of heroin-associated nephropathy (HAN). Typically, HAN presents with massive proteinuria and progresses rapidly to renal failure. Presumptive evidence supports the premise that heroin or its vehicles elicits immunologically mediated renal damage. The antigen still is unidentified. Removing the antigenic challenge by stopping heroin injection apparently interdicts the progression of renal disease. Renal transplantation can be effectively accomplished in patients with HAN without early recurrence if patients discontinue the use of heroin.

Topics: Acute Kidney Injury; Adult; Female; Glomerulonephritis; Heroin; Heroin Dependence; Humans; Kidney Diseases; Kidney Transplantation; Male; Middle Aged; Myoglobinuria; Polyarteritis Nodosa; Prognosis; Proteinuria; Sepsis; Syndrome; Transplantation, Homologous

Topics: Acute Kidney Injury; Adult; Heroin; Heroin Dependence; Humans; Male; Myoglobinuria; Paralysis

Topics: Acute Kidney Injury; Adult; Biopsy, Needle; Heroin; Heroin Dependence; Humans; Male; Muscles; Muscular Diseases; Myoglobinuria; Substance-Related Disorders

Topics: Acute Kidney Injury; Adult; Biopsy; Electromyography; Heroin; Humans; Leg; Male; Morphine Dependence; Muscles; Muscular Diseases; Myoglobinuria; Pulmonary Edema

Topics: Acute Kidney Injury; Adult; Aspartate Aminotransferases; Barbiturates; Chlorpromazine; Coma; Drug-Related Side Effects and Adverse Reactions; Female; Glutethimide; Heroin; Humans; Kidney Function Tests; L-Lactate Dehydrogenase; Male; Methadone; Methamphetamine; Muscular Diseases; Myoglobinuria; Phosphocreatine; Pyruvate Kinase; Quinine; Substance-Related Disorders

Topics: Adolescent; Adult; Brain Abscess; Brain Edema; Cerebral Hemorrhage; Deafness; Heroin; Humans; Male; Meningitis; Myelitis, Transverse; Myoglobinuria; Myositis; Neuritis; Neurocognitive Disorders; Polyradiculopathy; Substance-Related Disorders; Tetanus

Topics: Adolescent; Adult; Aged; Child; Female; Heroin; Humans; Hypokalemia; Male; Malignant Hyperthermia; Middle Aged; Muscular Dystrophies; Myoglobinuria; Physical Exertion; Recurrence

Topics: Acute Disease; Acute Kidney Injury; Adult; Autopsy; Cell Membrane Permeability; Drug Contamination; Electromyography; Heroin; Humans; Injections, Intravenous; Injections, Subcutaneous; Male; Muscle Contraction; Muscular Diseases; Myoglobin; Myoglobinuria; Rest; Substance-Related Disorders; Time Factors