heroin and Rhabdomyolysis

Rhabdomyolysis is a potentially life-threatening condition induced by diverse mechanisms including drugs and toxins. We aimed to investigate the incidence of rhabdomyolysis occurrence in intoxicated patients with psychoactive substances. In this review, three databases (PubMed, Scopus, Web of Science) and search engine (Google Scholar) were searched by various keywords. After the screening of retrieved documents, related data of included studies were extracted and analyzed with weighted mean difference (WMD) in random effect model. The highest incidence of rhabdomyolysis was observed in intoxication with heroin (57.2 [95% CI 22.6-91.8]), amphetamines (30.5 [95% CI 22.6-38.5]), and cocaine (26.6 [95% CI 11.1-42.1]). The pooled effect size for blood urea nitrogen (WMD = 8.78, p = 0.002), creatinine (WMD = 0.44, p < 0.001), and creatinine phosphokinase (WMD = 2590.9, p < 0.001) was high in patients with rhabdomyolysis compared to patients without rhabdomyolysis. Our results showed a high incidence of rhabdomyolysis induced by psychoactive substance intoxication in ICU patients when compared to total wards. Also, the incidence of rhabdomyolysis occurrence was high in ICU patients with heroin and amphetamine intoxication. Therefore, clinicians should anticipate this complication, monitor for rhabdomyolysis, and institute appropriate treatment protocols early in the patient's clinical course.

Topics: Central Nervous System Agents; Creatinine; Heroin; Humans; Incidence; Rhabdomyolysis

Topics: Amphetamine; Cocaine; Diagnosis, Differential; Heroin; Humans; Methamphetamine; Prognosis; Rhabdomyolysis; Solvents; Substance-Related Disorders

Medical complications of heroin overdose and the diseases of addicts play an increasingly important role in the daily routine of hospital medical departments. The percentage of drug-related admissions to the Medical Clinic of the University Hospital, Zürich, increased from 0.18% to 4.45% between 1972 and 1983. During this 12-year period, 492 patients were admitted 569 times because of heroin overdose or intoxications combined with other drugs, and 191 drug addicts were hospitalized 226 times for a variety of medical problems. Certain complications, such as heroin pulmonary edema and talc granulomas of the lung, occur only in parenteral drug addiction. Other diseases such as right heart endocarditis, Candida-endophthalmitis, septic arthritis and osteomyelitis are almost exclusively observed in intravenous drug abusers. Sexually transmitted infections and hepatitis B are frequently diagnosed in addicts.

Topics: Adolescent; Adult; Age Factors; Arthritis, Infectious; Candidiasis; Cardiovascular Diseases; Endocarditis, Bacterial; Female; Hepatitis, Viral, Human; Heroin; Heroin Dependence; Humans; Length of Stay; Lung Diseases; Male; Nervous System Diseases; Osteomyelitis; Pulmonary Edema; Rhabdomyolysis; Sex Factors; Sexually Transmitted Diseases; Skin Diseases; Switzerland

The term rhabdomyolysis describes a damage involving striated muscle cells or fibers, often complicated by acute kidney injury. This syndrome can have different causes, but it is generally divided into two main categories: traumatic and non-traumatic rhabdomyolysis. Among medical causes, drugs and abuse substances play a pivotal role, being opioids, alcohol, cocaine and other substances of abuse. Among drugs, the case of statins is certainly the best known. Here we describe a paradigmatic case of a man treated with success and good tolerance for years with rosuvastatin, who developed a severe rhabdomyolysis complicated by AKI needing hemodialysis, after the assumption of two substances of abuse (cocaine and heroin). Emergency physicians need to be aware of this syndrome, since it must be clinically suspected in order to ask the Laboratory for appropriate tests. Given that troponins are now widely accepted as the unique biochemical "gold standard" for diagnosing acute coronary syndromes, CK and myoglobin (the "gold standard" tests for diagnosing rhabdomyolysis) have been erased from admission test panels of the vast majority of emergency departments.

Topics: Acute Kidney Injury; Cocaine; Heroin; Humans; Male; Middle Aged; Rhabdomyolysis; Rosuvastatin Calcium

Low plasma potassium level can cause muscle weakness, lassitude, constipation as well as rhabdomyolysis and arrhythmias, when severe. In muscle, low plasma potassium increases resting membrane potential (hyperpolarization) of myocytes that tend to make muscle more refractory to excitation, leading to muscle weakness. Hypokalemia can be associated with a myriad of causes including drugs of abuse. We present a case of hypokalemia and muscle weakness following use of cocaine and heroin.

Topics: Adult; Arrhythmias, Cardiac; Cocaine; Constipation; Female; Heroin; Humans; Hypokalemia; Muscle Weakness; Potassium; Quadriplegia; Rhabdomyolysis; Substance-Related Disorders

While the risk of opioid overdose is widely accepted, the dangers of opioid withdrawal are far less clearly defined. The purpose of this publication is to provide evidence against the erroneous clinical dictum that opioid withdrawal is never life-threatening.. This case report (N = 1) illustrates an unfortunate, common scenario of a man abusing prescription opioids and heroin. His attempt at self-detoxification with buprenorphine-naloxone resulted in life-threatening opioid withdrawal. A detailed account of each day of his withdrawal period was documented by patient and family report and review of all medical records. The patient was contacted three months after hospitalization to verify information and determine progress in treatment and abstinence from drugs and alcohol.. A review of the literature was completed on severe cases of precipitated and spontaneous opioid withdrawal followed by a discussion of the significance as it relates to this case.. Given the widespread use of prescription opioids and opioid maintenance treatment, physicians should be aware of the complications of acute opioid withdrawal and should be equipped to treat these complications.

Topics: Acute Kidney Injury; Administration, Intranasal; Administration, Oral; Administration, Sublingual; Analgesics, Opioid; Buprenorphine, Naloxone Drug Combination; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Intensive Care Units; Male; Opioid-Related Disorders; Oxycodone; Oxymorphone; Prescription Drugs; Rhabdomyolysis; Self Medication; Substance Withdrawal Syndrome; Young Adult

Heroin exposure can cause various complications like seizures, stroke, spongiform encephalopathy, transverse myelopathy, plexopathy, compartment syndrome, rhabdomyolysis and renal failure due to various mechanisms. We report here a young male who smoked heroin for the first time and developed transverse myelitis, rhabdomyolysis and acute kidney injury requiring dialysis. His renal recovery was complete by four weeks, while neurological improvement occurred 8 to 12 weeks later. This case suggests a common pathogenic mechanism of heroin intoxication involving multiple systems of the body.

Topics: Acute Kidney Injury; Adult; Heroin; Humans; Inhalation; Magnetic Resonance Imaging; Male; Myelitis, Transverse; Narcotics; Rhabdomyolysis

There are several complications associated with heroin abuse, some of which are life-threatening. Methadone may aggravate this problem.. A clinical case description.. A 33-year-old man presented with rhabdomyolysis and cerebral ischemic stroke after intravenous heroin. He had used heroin since age 20, and had used 150 mg methadone daily for 6 months. He was found unconsciousness at home and was sent to our hospital. In the ER, his opiate level was 4497 ng/ml. In the ICU, we found rhabdomyolysis, acute renal failure and acute respiratory failure. After transfer to an internal ward, we noted aphasia and weakness of his left limbs. After MRI, we found cerebral ischemic infarction.. Those using methadone and heroin simultaneously may increase risk of rhabdomyolysis and ischemic stroke. Patients under methadone maintenance therapy should be warned regarding these serious adverse events. Hypotheses of heroin-related rhabdomyolysis and stroke in heroin abusers are discussed.

Topics: Adult; Brain; Brain Damage, Chronic; Cerebral Cortex; Cerebral Hemorrhage; Cerebral Infarction; Dominance, Cerebral; Drug Interactions; Electroencephalography; Heroin; Heroin Dependence; Humans; Intensive Care Units; Magnetic Resonance Imaging; Male; Methadone; Narcotics; Rhabdomyolysis; Substance Abuse Treatment Centers; Substance Abuse, Intravenous; Tomography, X-Ray Computed

Topics: Adult; Cerebral Cortex; Cerebral Infarction; Drug Synergism; Globus Pallidus; Heroin; Heroin Dependence; Humans; Male; Methadone; Narcotics; Neurologic Examination; Rhabdomyolysis; Substance Abuse Treatment Centers; Substance Abuse, Intravenous

Heroin abuse causes various medical and surgical complications. We report a case of heroin-induced severe bilateral compartment syndrome complicated by rhabdomyolysis, acute renal failure and extremely elevated creatinine kinase. A 30-year-old male heroin addict presented to the emergency department of Mount Vernon Hospital, Mount Vernon, New York complaining of severe pain and burning sensation in both legs and feet 1 day after abusing intravenous heroin. He had severe swelling and tenderness of both legs and feet. Laboratory data revealed tremendous elevation of creatine kinase (236,000 IU/L) consistent with rhabdomyolysis. Acute renal failure developed over subsequent days. Treatment consisted of fasciotomy, hyperbaric oxygen therapy (HBO2) and supportive therapy. The condition gradually improved over 4 weeks and the patient did not require dialysis or amputation.

Topics: Acute Kidney Injury; Adult; Compartment Syndromes; Heroin; Humans; Hyperbaric Oxygenation; Male; Rhabdomyolysis

The survival of heroin overdose patients resuscitated from cardiac arrest is reported to be poor. The aim of our study was to investigate the outcome and characteristics of survivors after cardiac arrest caused by heroin overdose.. This was a retrospective study in a medium-sized city (population, 560,000). Between 1 January 1997 and 31 December 2000, there were 94 combined cardiac arrests caused by acute drug poisonings. The main outcome measure was survival to discharge.. Cardiopulmonary resuscitation was attempted in 19 heroin overdose patients (group A) and in 53 patients with cardiac arrest caused by other poisonings (group B). Three (16%) vs. six (11%) patients were discharged alive (group A vs. B, respectively). The survivors in group A had an Emergency Medical Service (EMS)-witnessed cardiac arrest or the Emergency Dispatching Centre was called before the arrest occurred. There was no statistically significant difference between the two groups in terms of survival. Survivors in both groups suffered from acute renal failure (two), hypoglycaemia (four) and hypothermia (three).. Survival after cardiac arrest caused by heroin overdose is possible if the arrest is EMS witnessed or the Emergency Dispatching Centre is called before the cardiac arrest occurs. In comparison with cardiac arrests caused by other poisonings, there was no difference in survival. The incidence and mechanism of hypoglycaemia should be examined in further studies.

Topics: Adult; Cardiac Output; Cardiopulmonary Resuscitation; Drug Overdose; Emergency Medical Services; Epinephrine; Female; Finland; Heart Arrest; Heroin; Heroin Dependence; Humans; Hypoglycemia; Male; Middle Aged; Narcotics; Rhabdomyolysis; Survival; Vasoconstrictor Agents

Heroin-related peripheral nervous injury has scarcely been reported, mostly as compressive neuropathy. Rarely, other types of peripheral nervous system (PNS) injury have been recognized, such as plexopathy, polyradiculopathy, mononeuropathy, and rhabdomyolysis. These complications are usually not related to local trauma, but the nature of nerve injury remains unknown. Immunologic mechanisms have been proposed, although generally there is no laboratory evidence of inflammation and usually there is no improvement following steroid therapy. We describe six patients who developed acute PNS injury following intravenous or intranasal heroin self-administration with no evidence of compression injury or inflammation. Four patients had plexopathy (two lumbosacral and two brachial), and two had symmetric distal axonal sensorimotor neuropathy affecting the lower extremities. Of the six patients, five had concomitant rhabdomyolysis (creatine kinase, CK: 5,000-100,000 U/l) and one patient with brachial plexopathy had normal CK levels. The neurological deficit was noticed 3-36 h after heroin administration. Electromyography in five patients was consistent with sensorimotor axonal loss either confined to the affected plexus or with a diffuse distribution in the legs in the two patients with neuropathy. We propose that a toxic mechanism may be responsible for non-compression cases of acute neuropathy following heroin abuse.

Topics: Adult; Electromyography; Heroin; Humans; Male; Peripheral Nervous System Diseases; Rhabdomyolysis; Sural Nerve

We report the case of a young man with heroin intoxication. While deeply unconscious, he sustained a compartment syndrome of the arm and shoulder region leading to a lesion of the upper plexus. Immediate surgical decompression by fasciotomy incisions, intensive care treatment including hemofiltration to treat myoglobinemia, intense physical exercise, and mesh-grafting closure of the wounds soon led to unexpected recovery. The function of the arm was restored in such a way that the patient was able to intoxicate himself again. He needed intubation and ventilation but recovered uneventfully.

Topics: Adult; Brachial Plexus; Compartment Syndromes; Drug Overdose; Fasciotomy; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Male; Muscle, Skeletal; Neurologic Examination; Paralysis; Rhabdomyolysis; Substance Abuse, Intravenous

Clinical and scintigraphic findings are described in a patient with unexpected diffuse lung uptake on bone scan after a heroin overdose.. The patient's Tc-99m MDP bone scan is reviewed along with the pertinent clinical history and laboratory findings.. Marked diffuse and symmetric lung uptake is present on bone scintigraphy in a patient with a history of acute renal failure and a markedly elevated calcium-phosphate product but normal renal function and laboratory values at the time of the examination.. The incidental observation of metastatic calcification by bone scintigraphy is important, because it may aid in the diagnosis of a previously unsuggested elevated calcium-phosphate product, renal failure, or both. Furthermore, the intensity of tracer localization on bone tracer-specific imaging may help evaluate the activity of the metastatic calcification process.

Topics: Acute Kidney Injury; Adult; Bone and Bones; Calcinosis; Drug Overdose; Heroin; Heroin Dependence; Humans; Lung Diseases; Male; Narcotics; Radionuclide Imaging; Radiopharmaceuticals; Rhabdomyolysis; Technetium Tc 99m Medronate

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

We report a 30-year-old man who developed painful swelling of his right leg and complete sciatic nerve palsy after an i.v. injection of heroin. Excessive elevation of serum creatine phosphokinase indicated the presence of rhabdomyolysis. Fasciotomy of the gluteus maximus led to rapid and complete recovery from sciatic nerve palsy. Nontraumatic rhabdomyolysis may cause a gluteal compartment syndrome that requires immediate fasciotomy.

Topics: Adult; Buttocks; Heroin; Humans; Inflammation; Injections, Intravenous; Leg; Male; Paralysis; Peripheral Nervous System Diseases; Rhabdomyolysis; Sciatic Nerve; Substance-Related Disorders; Syndrome

Topics: Adult; Analgesics; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antioxidants; Arm; Combined Modality Therapy; Drug Overdose; Edema; Heroin; Heroin Dependence; Humans; Male; Methylprednisolone; Muscular Diseases; Oxygen Inhalation Therapy; Pain; Rhabdomyolysis; Syndrome

Here we report the clinical and pathological findings in a 30-year-old drug addict in whom an intravenous injection of heroin led to reversible coma with respiratory depression and heart failure. On regaining consciousness, the patient was found to have rhabdomyolysis with renal failure requiring dialysis and peripheral neuropathy. Three weeks later his neurological condition suddenly deteriorated and delayed encephalopathy developed, leading to death 20 days later. The neuropathological study of the brain disclosed pale, spongy myelin with diffuse reactive astrogliosis and microglial proliferation, without hypoxic necrotic lesions. The cerebral and cerebellar cortices were unchanged. The absence of typical hypoxic lesions and the presence of spongiosis with massive astrocytosis distinguished this case from the previously reported cases of delayed leukoencephalopathy following severe hypoxia. An immunocytochemical study designed to exclude an underlying alteration of the metabolic oxidative pathway detected normal expression of the respiratory chain complexes IV, III and V. Despite the absence of an oxidative chain alteration in our patient, we cannot exclude the possibility that an individual predisposition played a pathogenetic role in this delayed leukoencephalopathy.

Topics: Adult; Brain Diseases; Demyelinating Diseases; Heroin; Humans; Immunohistochemistry; Injections, Intravenous; Male; Rhabdomyolysis; Substance Abuse, Intravenous

Topics: Acute Kidney Injury; Adolescent; Compartment Syndromes; Drug Overdose; Heroin; Humans; Male; Rhabdomyolysis

We report a case of biopsy proven myocardial damage after opiate-induced rhabdomyolysis. Myocardial biopsy showed focal lesions formed by small mononuclear inflammatory cells with a few neutrophils, associated with degenerated and necrotic myocardial fibers, interstitial edema and congestion of intrinsic blood vessels. These findings were similar to those seen with other drug overdoses if combined with strenuous muscular effort or hypoxic coma. We hypothesize that myocardial damage is a consequence of intracapillary myohypoxia associated with prolonged hypoxic coma following opiate overdose.

Topics: Adult; Biopsy; Cardiomyopathies; Cell Hypoxia; Coma; Drug Overdose; Heart; Heroin; Humans; Male; Myocardium; Narcotics; Necrosis; Rhabdomyolysis

There are several neuromuscular complications in the intravenous heroin addict (IHA). Someone may be due to direct toxic effect of the substance, but other ones may be associated to abuser's typical diseases (i.e. HIV infection). We present a 27 year-old IHA patient, HIV positive, that develop acute rhabdomyolisis with severe neuromuscular involvement, and consistent clinical and electrodiagnostic features of lumbosacral plexus neuropathy, forteen hours after an heroin inyection. Thirty months later, the patient is severely disabled, but her initial painfull and paretic picture have improved. The association of rhabdomyolisis-lumbosacral plexopathy (RLPS) is ocasionally reported. It has been proposed that RLSP is etiologically related to mecanic, toxic and immunologic factors.

Topics: Adult; Heroin; Humans; Lumbosacral Plexus; Male; Peripheral Nervous System Diseases; Rhabdomyolysis; Substance Abuse, Intravenous

We report on two patients with severe rhabdomyolysis and peripheral nerve involvement after drug intoxication. Nerve conduction studies of the paretic extremities of both patients could be performed within 12 h of the onset. Several nerves revealed evidence of conduction blocks in the paretic extremities. One of the patients who had taken heroin died and postmortem examination was performed. A drug-induced immune vasculitis could not be demonstrated. Besides striated muscle necrosis, extensive myocardial fragmentation was shown. Territorial ischemia, resulting from systemic hypotension and mechanical compression of arteries, seems to have been the cause of the myonecroses and peripheral nerve damage in the unconscious patients.

Topics: Adolescent; Adult; Cannabinoids; Ethanol; Fatal Outcome; Female; Flunitrazepam; Heart Arrest; Heroin; Humans; Illicit Drugs; Ischemia; Leg; Male; Muscle, Skeletal; Neurologic Examination; Peripheral Nerves; Psychotropic Drugs; Rhabdomyolysis; Substance-Related Disorders; Synaptic Transmission

After intravenous injection of heroin, a 27-year-old male with altered mental status and hypotension was seen at the Emergency Service where acute pulmonary edema was noted. The problem was resolved three days later after oxygen therapy had been administered by face mask. Acute renal failure, rhabdomyolysis and monoplegia of the patient's left leg were exhibited during his stay at the Intensive Care Unit. Neurological examination and electro-diagnostic studies (electromyography and nerve conduction velocity) showed left lumbosacral plexitis. Hemodialysis was given. Though the patient's hospital course was uneventful, satisfactory recovery from his left leg weakness, which persisted for one year after hospital discharge, was finally achieved.

Topics: Acute Disease; Acute Kidney Injury; Adult; Heroin; Humans; Lumbosacral Plexus; Male; Neuritis; Pulmonary Edema; Rhabdomyolysis

Heroin addiction is known to cause various medical and neurological complications. We report here a case of rhabdomyolysis following heroin abuse, in which a neurological lesion mimicking transverse myelitis was also noted. A 29-year-old man was found comatose in a kneeling position one day after a heroin overdose. On admission, he was awake, yet with total paralysis of his lower legs. Physical examination revealed marked swelling and tenderness of the four limbs, especially the lower extremities. Deep tendon reflexes and positional sense were absent in both legs; however, pin-prick sense was preserved. Transverse myelitis or spinal cord vasculitis was the initial working diagnosis. Laboratory tests disclosed significantly elevated creatinine kinase of 146289 U/L. Though suffering transient acute renal failure, his neurological abnormalities gradually improved over four weeks and a left foot drop was the only residual lesion at discharge. Rhabdomyolysis, a well defined complication following heroin use, may also cause concomitant neurological symptoms, for which careful differential diagnosis is warranted. With the increasing number of heroin addicts in Taiwan, more cases with rhabdomyolysis-induced neurological symptoms may be observed in the future.

Topics: Adult; Creatine Kinase; Diagnosis, Differential; Heroin; Humans; Male; Myelitis, Transverse; Paralysis; Rhabdomyolysis

Gluteal compartment syndrome is a rare disorder that most often occurs in conjunction with prolonged immobility after a sedative overdose but also may result from direct trauma. Patients present with localized tenderness, induration, and pain with passive flexion of the gluteal muscles. Signs of sciatic nerve compression occur frequently, and rhabdomyolysis may be associated with the syndrome. If the diagnosis of gluteal compartment syndrome is suspected, intracompartmental pressures should be measured. If pressures are high or if sufficient clinical suspicion remains, the patient should undergo prompt fasciotomy.

Topics: Adult; Alcoholism; Buttocks; Compartment Syndromes; Emergencies; Heroin; Humans; Male; Pressure; Rhabdomyolysis; Substance-Related Disorders

Topics: Acute Kidney Injury; Administration, Inhalation; Adult; Heroin; Humans; Male; Rhabdomyolysis

A wide spectrum of acute and chronic neurological syndromes are associated with heroin addiction. We report two cases with acute brachial/lumbar plexus lesions, with details of the clinical findings, diagnostic procedures and therapy. Possible causes are allergic or toxic reactions to heroin or added substances, as well as nerve compression due to local muscle swelling in connection with rhabdomyolysis. The extent of paresis which occurs is also determined by this compression.

Topics: Acute Kidney Injury; Adult; Brachial Plexus; Drug Overdose; Heroin; Heroin Dependence; Humans; Lumbosacral Plexus; Male; Nerve Compression Syndromes; Neurologic Examination; Rhabdomyolysis

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

A 24 year ald-man, was admitted in intensive care with coma and shock, 4 hours after intravenous injection of heroin. Awakening was obtained by naloxone. Diagnosis of acute rhabdomyolysis associated with heroin addiction was asserted by association of anury, hyperkalemia, and CPK increase. Recovery was obtained with, however, neurologic after-effects. Pathophysiology of acute rhabdomyolysis associated with heroin addict is obscure. Hypotheses for the cause of the muscle damage include the effects of toxicity (either directly or immunologically mediated) of the drug or an adulterant. However prolonged coma and immobilization in one position with either direct compression of the muscles or occlusions of the regional vascular supply can play a major role.

Topics: Acute Disease; Adult; Heroin; Humans; Male; Rhabdomyolysis

We report about a young female patient who suffered a rhabdomyolysis and a plexus lesion after heroin intoxication. A computer-tomography was made to reveal the extent of myonecrosis. A larger rhabdomyolysis of muscles of the pelvis and left thigh was seen. A residual paresis of the left N. peronaeus existed at discharge of the patient.

Topics: Adult; Female; Heroin; Humans; Lumbosacral Plexus; Peripheral Nervous System Diseases; Peroneal Nerve; Rhabdomyolysis; Suicide, Attempted

Topics: Administration, Oral; Adult; Heroin; Humans; Male; Rhabdomyolysis

Topics: Acute Kidney Injury; Cocaine; Heroin; Humans; Rhabdomyolysis; Substance-Related Disorders

Thirteen patients developed a renal disease after using heroin alone or in combination with other drugs, for a period of 3 to 12 years. Eleven were IV drug addicts, 2 were sniffers. Six patients had acute tubular necrosis, due to rhabdomyolysis in 5 and to prolonged gentamicin therapy for bacterial endocarditis in 1. Five patients manifested a nephrotic syndrome, and renal biopsy showed various types of glomerulonephritis (GN) without glomerular sclerosis. The two last patients had hypertension with intrarenal vascular lesions and HBsAg was present in their serum. Chronic hemodialysis and/or renal transplantation were required in 2 cases with GN; all other patients recovered normal serum creatinine. There was no specific pathologic picture of heroin abuse in this series.

Topics: Adult; Endocarditis, Bacterial; Female; Gentamicins; Glomerulonephritis; Heroin; Humans; Hypertension, Renovascular; Kidney; Kidney Diseases; Kidney Tubular Necrosis, Acute; Male; Rhabdomyolysis; Substance-Related Disorders

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

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

Topics: Adolescent; Flunitrazepam; Heroin; Humans; Male; Rhabdomyolysis; Substance-Related Disorders

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

Eight young addicts developed rhabdomyolysis as a complication of heroin overdose. ECG, plasma enzyme time activity curves and thallium myocardial scintigraphy were highly suggestive of a myocardial lesion associated with rhabdomyolysis. Such changes were particularly striking in 3 patients with acute left ventricular failure, as shown by a hemodynamic investigation (3 patients) and by echocardiography (1 patient). All patients recovered but myocardial scintigraphy and ECG remained abnormal for a period ranging from 8 months to 3 years following the acute episode. Although associated metabolic changes may play a role in myocardial dysfunction, the most likely mechanism appears to be a direct toxic effect of heroin on cardiac muscle.

Topics: Adult; Cardiomyopathies; Electrocardiography; Heart; Heroin; Heroin Dependence; Humans; Male; Radioisotopes; Rhabdomyolysis; Thallium

Topics: Creatine Kinase; Heroin; Heroin Dependence; Humans; Muscles; Peptide Hydrolases; Rhabdomyolysis

A report is presented on two patients with massive rhabdomyolysis following heroin intoxication. Due to massive muscle edema of the lower legs, both patients needed early fasciotomy to prevent compression syndrome. The two cases followed a different course as regards complications and especially renal insufficiency and disorders of serum calcium and phosphorus regulation. Pathophysiology, prevention and therapy of complications are discussed. As a result of intensive physiotherapy, the long term functional outcome was satisfactory in both cases.

Topics: Acute Kidney Injury; Adolescent; Adult; Female; Heroin; Heroin Dependence; Humans; Leg; Male; Rhabdomyolysis; Tomography, X-Ray Computed; Water-Electrolyte Imbalance