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[Acute rhabdomyolysis in alcoholic patients]
Abstract:
Six episodes of acute rhabdomyolysis were observed within a two-year period in 5 male adult alcoholic patients hospitalised in a hepatology intensive care unit. Painful muscle swelling was discrete of absent in 4 of the 5 patients. Acute rhabdomyolysis was preceded by grand mal seizures in 4 patients, delirium tremens in 1 and high fever with shivers in 3. All cases were rapidly diagnosed on the finding of very high serum creatinine phosphokinase levels. One patient developed acute respiratory failure and recovered after prolonged mechanical ventilation. Three patients had acute renal failure with severe hyperkalemia in one but none required dialysis. Three patients died within 2 to 6 days of the diagnosis, but the deaths were not directly related to rhabdomyolysis. It would appear that in alcoholic patients: the prevalence of rhabdomyolysis is probably underestimated; any muscular hyperactivity as seen in seizures, delirium tremens and prolonged shivers may be a precipitating factor; the condition is easily diagnosed by measuring serum creatinine kinase activity; some cases of acute renal failure in patients with alcoholic cirrhosis might be explained by acute rhabdomyolysis with minimal symptoms.
Insights
Alcoholic patients can develop acute rhabdomyolysis, a muscle breakdown condition, often without significant muscle pain. Muscular hyperactivity, such as seizures, can trigger this potentially underdiagnosed condition.
Area of Science:
- Hepatology
- Intensive Care Medicine
- Neurology
Background:
- Alcoholic patients admitted to intensive care units may be at risk for underdiagnosed conditions.
- Acute rhabdomyolysis is a serious medical condition involving muscle breakdown.
Observation:
- Five male adult alcoholic patients in a hepatology ICU experienced six episodes of acute rhabdomyolysis over two years.
- Muscle swelling was minimal or absent in most patients.
- Precipitating factors included seizures, delirium tremens, and high fever with shivers.
Findings:
- Diagnosis was rapid, based on elevated serum creatinine phosphokinase (CPK) levels.
- One patient experienced acute respiratory failure requiring mechanical ventilation.
- Three patients developed acute renal failure; none required dialysis.
- Three patients died within a week, unrelated to rhabdomyolysis.
Implications:
- The prevalence of rhabdomyolysis in alcoholic patients may be underestimated.
- Muscular hyperactivity can precipitate rhabdomyolysis in this population.
- Elevated CPK is a reliable diagnostic marker.
- Rhabdomyolysis may explain some cases of acute renal failure in patients with alcoholic cirrhosis, even with subtle symptoms.