Electrolyte balance and muscle damage after adolescent binge alcohol use: a retrospective study

Binge alcohol drinking is a recognized cause of peripheral muscle damage, leading to increased creatine kinase levels. However, the potential role of electrolyte and osmolality changes in muscle damage remains unclear. This study investigates the prevalence of muscle damage in adolescents after binge drinking and its association with ethanol, potassium, sodium, calcium, and osmolality levels.

A retrospective review of medical records from the Pediatric Emergency Department, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, was conducted. The study included 150 adolescents (13.2 to 18.0 years of age, female to male ratio 1.03) diagnosed with binge drinking between 2013 and 2023. Exclusion criteria encompassed muscle trauma, crush syndrome, pre-existing conditions, or medications affecting muscle metabolism and electrolyte balance. Muscle damage was defined as creatine kinase levels exceeding 1.5 times the upper limit of normal.

Muscle damage was identified in 61 (41%) cases, predominantly in males (female to male ratio 0.24; p < 0.0001). Ethanol levels (1.87 [1.57-2.30] versus 2.01 [1.61-2.36] g/L; median and interquartile range), potassium (3.6 [3.3-3.9] versus 3.7 [3.5-3.9] mmol/L), sodium (140 [139-142] versus 140 [138-142] mmol/L), total calcium (2.31 [2.27-2.37] versus 2.29 [2.25-2.31]; mmol/L), albumin-adjusted calcium (2.27 [2.22-2.32] versus 2.29 [2.18-2.31]; mmol/L), effective osmolality (286 [283-290] versus 287 [284-290] mosm/kg), and total osmolality (333 [326-342] versus 337 [326-342] mosm/kg) were similar in individuals without and with muscle damage.

In adolescents, muscle damage is common after binge alcohol drinking, particularly in males. The pathogenesis appears to be independent of ethanol concentration, electrolyte imbalances, and osmolality changes.