Patients in Rhabdomyolysis Presenting to the Emergency Department.

Area of Science:

• Emergency Medicine
• Nephrology
• Toxicology

Background:

• Rhabdomyolysis is a critical condition characterized by muscle breakdown, potentially leading to acute kidney injury.
• While commonly linked to extreme exercise and immobility, various other factors can precipitate rhabdomyolysis.
• Understanding the spectrum of causes and patient presentations is vital for effective emergency department (ED) management.

Purpose of the Study:

• To describe the clinical characteristics of patients presenting with rhabdomyolysis in the ED.
• To identify the immediate and proximate causes of rhabdomyolysis in this patient population.
• To specifically investigate the association between substance abuse and rhabdomyolysis, including compartment syndrome.

Main Methods:

• A retrospective descriptive review was conducted on 308 patients presenting to two South Florida EDs from January 2017 to December 2018.
• Inclusion criteria included a creatine phosphokinase level ≥1000 or an ED diagnosis of rhabdomyolysis.
• Data collected encompassed immediate and proximate causes, presenting complaints, symptoms, and substance use.

Main Results:

• The most common immediate causes were injury/prolonged immobility (58.1%), neurologic/psychiatric conditions (18.2%), and intentional exercise (16.2%).
• Illicit drug use (28.6%) and infectious diseases (16.9%) were identified as frequent proximate causes.
• Prevalent symptoms included fatigue/weakness (47.1%), altered mental status (29.2%), and extremity pain (24.7%). Substance use was noted in 24.0% for drugs and 29.9% for alcohol.

Conclusions:

• Injury, immobility, and substance abuse are significant contributors to rhabdomyolysis.
• Hyperactive delirium with severe agitation was also a notable cause.
• This analysis provides crucial clinical insights for emergency physicians managing rhabdomyolysis patients, particularly those with substance use disorders.