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Methamphetamine abuse and rhabdomyolysis in the ED: a 5-year study
J R Richards1, E B Johnson, R W Stark
1Division of Emergency Medicine, University of California, Davis Medical Center, Sacramento, USA.
Abstract:
Patients with methamphetamine toxicity are presenting in greater numbers each year to emergency departments (ED) in the US. These patients are frequently agitated, violent, and often require physical and chemical restraint. The incidence and risk of rhabdomyolysis in this subpopulation is unknown. We conducted a 5-year retrospective review of all ED patients who received the final diagnosis of rhabdomyolysis. Patients with toxicology screens positive for methamphetamine were identified, and demographics, laboratory results, resource utilization, disposition, and outcome were compared to the remaining patients. Of the total 367 patients identified, 166 (43%) were toxicology positive for methamphetamine. Methamphetamine patients differed significantly from nonmethamphetamine patients with regard to demographics and hospital utilization. Methamphetamine patients had significantly higher mean initial creatine phosphokinase (CK), 12,439 U/L versus 5,678 U/L (P = 0.02), and lower mean peak CK, 16,827 U/L versus 19,426 U/L (P = 0.03). The development of acute renal failure was not significantly different between the 2 groups. There were 16 total deaths in the study population, 11 from concomitant infection/sepsis. An association between methamphetamine abuse and rhabdomyolysis may exist, and CK should be measured in the ED as a screen for potential muscle injury in this subpopulation. Patients with rhabdomyolysis with an unclear cause should be screened for methamphetamine or other illicit drugs.
Insights
Methamphetamine toxicity is increasingly seen in emergency departments. This study suggests a possible link between methamphetamine abuse and rhabdomyolysis, recommending creatine phosphokinase (CK) screening for affected patients.
Area of Science:
- Emergency Medicine
- Toxicology
- Nephrology
Background:
- Increasing emergency department (ED) visits for methamphetamine toxicity present challenges.
- Patients often exhibit agitation and require physical or chemical restraint.
- The risk of rhabdomyolysis in this population is not well understood.
Purpose of the Study:
- To investigate the incidence and characteristics of rhabdomyolysis in patients with methamphetamine toxicity.
- To compare outcomes and hospital resource utilization between methamphetamine-positive and methamphetamine-negative rhabdomyolysis patients.
- To determine if methamphetamine abuse is associated with rhabdomyolysis.
Main Methods:
- Retrospective review of 367 patients diagnosed with rhabdomyolysis over 5 years.
- Identification of patients with positive methamphetamine toxicology screens.
- Comparison of demographics, laboratory results (creatine phosphokinase - CK), resource utilization, disposition, and outcomes.
Main Results:
- 166 (43%) patients tested positive for methamphetamine.
- Methamphetamine patients had significantly higher initial CK levels (12,439 U/L vs. 5,678 U/L, P=0.02).
- No significant difference in acute renal failure development; 11 of 16 deaths were due to infection/sepsis.
Conclusions:
- An association between methamphetamine abuse and rhabdomyolysis may exist.
- Consider measuring creatine phosphokinase (CK) in ED patients with suspected muscle injury and methamphetamine toxicity.
- Screen patients with unexplained rhabdomyolysis for methamphetamine or other illicit drug use.
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