Faculty of Medicine
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Item type:Publication, Rhabdomyolysis in patients following opioid overdose(2024-10-23); ; ; Rhabdomyolysis is a clinical entity characterized by the destruction of skeletal muscle with the resultant release of intracellular enzymatic content into the bloodstream, leading to systemic complications. This study aimed to determine the clinical and some of the biochemical findings in patients with rhabdomyolysis following opioid overdose. Methods: This study randomly recruited 140 patients suffering from rhabdomyolysis due to acute intoxication and was implemented for one year at the University Clinic for Toxicology. Rhabdomyolysis was defined as a creatine phosphokinase (CK) >250 U/L according to poisoning severity score (PSS). We included adult patients ≥ 18 years of age. We excluded patients with myocardial infarction, renal impairment, acute and chronic hepatitis B and C, and other hepatic impairments, based on the medical history. Results: Out of a total of 140 patients with rhabdomyolysis due to acute intoxication, 14.2 % (n=20) were opioid overdose (male n=19; female n=1). The average age of methadone patients was 36.7±6.6 and in heroin patients 33.6±9.3. On the first, third, and fifth days, serum creatine kinase (CK) values in heroin patients were 8925 vs. 6404.5 vs. 996 U/L, and for methadone overdose 5548.3 vs. 10300 vs. 2114 U/L. Severe rhabdomyolysis according to the PSS score occurs in methadone overdose 46.67% (n=7), and in heroin overdose 40% (n=2). Moderate rhabdomyolysis was observed in heroin overdose 40% (n=2) and in methadone overdose 40% (n=6). For mild rhabdomyolysis, we determined a heroin overdose of 20% (n=1) and a methadone overdose of 13.33% (n=2). Determined values of hs-cTnI in methadone overdose were (n=5) 279.7±190.7 µg/L, and in heroin overdose were (n=4) 78.48±28.88 µg/L. On the first, third, and fifth day, AST values in heroin overdose were 823 vs. 415 vs. 93.5 U/L, and for methadone 242 vs. 420 vs. 285 U/L. In the three measurement times, the highest values of urea in heroin patients were 10.1 vs. 27.2 vs. 20.2 mmol/L, and methadone 6.3 vs. 23 vs. 11.3 mmol/L, the highest values for creatine were in heroin 228 vs. 405.5 vs. 302.5 µmol/L and methadone overdose 108 vs. 199.8 vs. 483.5 µmol/L. Acute kidney injury (AKI) occurred in 21 patients of which heroin was 14.2% (n=3) and 28.5% (n=6) methadone. Renal replacement therapy was applied in 13 patients of which 15.3% (n=2) in heroin and 30.7% (n=4) in methadone overdose. Conclusion: Physicians should be aware that severe and moderate rhabdomyolysis occurs more often in patients with methadone and heroin overdose. Increased levels of CK, high-sensitivity troponin I, AST, urea, and, creatine were associated with opioid overdose and should be identified to initiate appropriate treatment. Acute kidney injury is a common complication in heroin and methadone overdose patients and often there is a need for renal replacement therapy. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Comparison of Rhabdomyolysis in Acutely Intoxicated Patients with Psychotropic and Chemical Substances(2023-06); ; ; ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, MYOGLOBIN IN ACUTELY INTOXICATED PATIENTS WITH RHABDOMYOLYSIS(Macedonian Association of Internal Medicine, 2022-05); ; ; ; Bekjarovski Niko - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Acute Complication After Heat Stroke in a Half Marathon Healthy Participant: Literature Review(Turkiye Klinikleri, 2022-01-10); ; ; ; Heat stroke is a set of symptoms that include a severe rise of body temperature that is usually but not always higher than 40ºC. Clin- ically, it is characterized by central nervous system dysfunction such as ataxia, delirium or cramps, in conditions of exposure to hot weather or strenuous physical exertion. We presented a 46-year-old male athlete who collapsed during a half marathon after running 20 km and 640 m in 2 hours and 2 minutes. He was brought to the clinic in an unconscious state febrile 38.6ºC with fasciculations, convulsions, hypotensive, tachycardic. During hospitalization with rhabdomyolysis and hypoxic hepatitis. It is crucial to recognize the clinical symptoms and signs in the acute phase of heat stroke and in areas with temperate continental climate, to begin timely treatment, to reduce mortality. Complications of heat stroke need to be diagnosed, appropriate treatment provided, to improve the prognosis of these conditions. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Comparison of aminotransferase activity in patients with rhabdomyolysis due to acute intoxication with psychotropic and chemical substances(GUARANT International spol. s r.o., 2021-12); ; ; ; Aims: We determine the aminotransferase activity in patients with rhabdomyolysis following acute intoxication with psychotropic and chemical substances. 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. Rhabdomyolysis was defined according to the poisoning severity score. To distinguish whether elevated AST and ALT are attributed only to muscle injury or concomitant liver damage, serum levels of AP, GGT, bilirubin, albumin, and prothrombin time were analyzed. Data were statistically analyzed in SPSS software, version 22.0 for Windows (SPSS, Chicago, IL, USA). Results: In acutely intoxicated patients with rhabdomyolysis, 60% had increased AST values, in the group with psychotropic intoxications, AST values were elevated by 43%, and in the group, with chemical intoxication, 17% of the subjects had elevated AST levels. Patients with rhabdomyolysis due to psychotropic intoxication on the fifth day have significantly higher AST (p = 0.0138) and ALT (p = 0.0129) than patients with chemical intoxication. The CPK / AST correlation on the first day was significantly stronger in psychotropic compared to chemical intoxications (p = 0.0009). In psychotropic intoxications we found significant linear positive moderate correlation (p = 0.0001) and in chemical intoxications non-significant linear positive had a very weak correlation (p = 0.003). With increasing CPK, ALT was significantly increased in psychotropic intoxication and was slightly increased in patients with chemical intoxication. Conclusion: Changes in AST and ALT values were correlated with CPK values, suggesting that elevated aminotransferases in rhabdomyolysis in those intoxicated with psychotropic substances may indicate skeletal muscle damage rather than hepatocyte damage. Elevated aminotransferases in chemical intoxications are due to the hepatotoxic effects of certain substances or can accompany severe clinical presentation with multiorgan failure. Intoxications with mushrooms, gasoline, corrosives, are the typical offending agent.