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Author: search.filters.author.Babulovska, AleksandraSubject: search.filters.subject.Creatine kinase

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    Acute kidney injury and necessity of renal replacement therapy in acutely intoxicated patients with rhabdomyolysis
    (Serbian Medical Society, 2024-03)
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    Naumovski, Kiril
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    Introduction/Objective - This study aimed to analyse the characteristics of the selective parameters related to the development of acute kidney injury and the necessity of renal replacement therapy in patients with rhabdomyolysis due to acute intoxication with psychotropic and chemical substances in the first 24 hours. Methods - In a clinically controlled prospective study, 140 patients with rhabdomyolysis were divided into two groups depending on the intoxicating substance, i.e., psychotropic or chemical. Patients were selected according to predetermined inclusion and exclusion criteria. Results - Acute kidney injury occurred in 15% of 140 patients with rhabdomyolysis of whom 14 (66.7%) had psychotropic intoxication and seven (33.3%) had chemical intoxication. Statistical analysis showed significantly increased prevalence in the psychotropic group compared to those with chemical intoxication (p 0.0002). Creatine kinase values for median interquartile range in patients without/with renal replacement therapy were in psychotropic – 753 (446–753) vs. 42,670 (22,357–42,670) U/L; and chemical – 478.3 (321.5–1111.9) vs. 648.6 (495.6–2065) U/L. In psychotropic intoxications this difference was significant (p = 0.00002), while in the chemical ones it was insignificant (p = 0.2885). The renal replacement therapy was applied in 13 (9.3%) patients with rhabdomyolysis, nine of which (69.2%) were with psychotropic intoxication and four (30.8%) were with chemical intoxication. Conclusion - The prevalence of acute kidney injury and necessity for necessity for renal replacement therapy was significantly higher in psychotropic intoxication compared to chemical intoxication. The level of creatine kinase and myoglobin on the first day in the group with psychotropic substances, and high-sensitivity troponin I in both groups –psychotropic and chemical substances – are significantly higher in patients who need renal replacement therapy compared to those who do not need this therapy.
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    Comparison of Rhabdomyolysis in Acutely Intoxicated Patients with Psychotropic and Chemical Substances
    (2023-06)
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    Introduction: Rhabdomyolysis is characterized by a muscle injury that leads to the release of intracellular muscle contents/constituents into the systemic circulation. Aim: We examined the association between the severity of the clinical presentation and creatinine phosphokinase values in patients with rhabdomyolysis acutely intoxicated with psychotropic and chemical substances. Materials and methods: This clinically controlled prospective study included 140 patients with rhabdomyolysis hospitalized at the University Clinic of Toxicology in 2019. They were divided into two groups by the substance used for intoxication (psychotropic or chemical). Results: On the third day of hospitalization, we found a significant association between the type of intoxication and the degree of rhabdomyolysis according to the poisoning severity score (p=0.0256). The significance was due to intoxications with neuroleptics – 50% (n=6), anticonvulsants – 20% (n=1), antidepressants – 16.67% (n=2), heroin – 25% (n=1), and methadone – 54% (n=6). According to the poisoning severity score, the majority of intoxicated patients with chemical substances – other gases 100% (n=1), and those intoxicated with psychotropic substances – methadone 46.67% (n=7), neuroleptics 42.67% (n=5), heroin 40% (n=2), antidepressants 8.33% (n=1), had severe rhabdomyolysis. In psychotropic intoxications, creatine kinase had a significant linear positive weak correlation with mortality (p=0.0234). Conclusions: Rhabdomyolysis and its clinical symptoms and signs were significantly more common in patients intoxicated with psychotropic substances compared to chemical intoxications. Intoxicated patients with psychotropic substances had more severe rhabdomyolysis on the third day of hospitalization. In psychotropic intoxication, with increasing creatine kinase level on the first day there was a significant increase in mortality.
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    Rhabdomyolysis and Aminotransferase Activity Due to Acute Intoxication With Psychotropic and Chemical Substances
    (Arak University of Medical Sciences, 2023-01)
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    Background: Rhabdomyolysis is caused by the release of enzymes from skeletal muscles into the blood, which leads to systemic complications with diverse etiologies. This study evaluated the serum aminotransferases in patients with rhabdomyolysis following acute intoxication with either psychotropic drugs or other chemical agents. Methods: This study randomly recruited 140 patients suffering from rhabdomyolysis. They were divided into two groups affected by either psychotropic drugs or chemical agents. Rhabdomyolysis was defined as having serum creatine kinase (CK) levels greater than 250 U/L, based on the poisoning severity score. Results: On day 1, the CK/AST correlation was significantly stronger in the psychotropic than the chemical group (P=0.0009). On day 5, patients in the psychotropic group had significantly higher AST (P=0.0138) and ALT (P=0.0129) than those poisoned with other chemicals. The difference in the strength of the CK/ALT correlation between the two groups was insignificant. Between the two groups, the differences between the CK levels and the following serum parameters were insignificant: Alkaline phosphatase; gamma-glutamyl transferase; prothrombin time; total bilirubin; and albumin. Conclusion: The elevated aminotransferases in patients with rhabdomyolysis due to acute psychotropic toxicity might have resulted from the skeletal muscle injury rather than hepatotoxicity. In rhabdomyolysis patients poisoned with other chemicals, the elevated serum aminotransferases are likely due to liver toxicity arising from the consumed substances. These patients are likely to manifest clinically severe long-term multi-organ failure. Intoxications with typical agents, such as herbicides, petroleum distillates, and corrosives were responsible for the rhabdomyolysis in the second group