Faculty of Medicine
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Item type:Publication, Acute kidney injury and necessity of renal replacement therapy in acutely intoxicated patients with rhabdomyolysis(Serbian Medical Society, 2024-03); ; ; - 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, 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Comparison of acute kidney injury and renal replacement therapy in patients with rhabdomyolysis acutely intoxicated with psychotropic or chemical substances(2021-05); ; ; ; Objective: We determine the risk factors for the development of acute kidney injury and the necessity of renal replacement ther- apy (RRT) for patients with rhabdomyolysis due to acute intoxica- tion with psychotropic and chemical substances. Methods: This was a prospective clinical study conducted from 1 January to 31 December 2019 at the University Clinic for Toxicology in Skopje. The study included patients with rhabdo- myolysis divided in to two groups in accordance with the sub- stance used for intoxication (psychotropic or chemical). Rhabdomyolysis was defined as a creatine phosphokinase (CPK) >250U/L. The diagnosis and the stages of the acute kidney injury were defined using the Kidney Disease: Improving Global Outcomes (KDIGO) classification. Data were statistically analyzed in SPSS software, version 22.0 for Windows (SPSS, Chicago, IL, USA). Results: Acute kidney injury occurred in 15% of 140 patients with rhabdomyolysis of whom 66.7% (n ¼14) had psychotropic intoxication and 33.3% had chemical intoxication (n ¼7). Statistical analysis showed significantly increased prevalence in the psychotropic group compared to those with chemical intoxi- cation (p ¼0.0002). The highest prevalence of acute kidney injury in the psychotropic intoxication group was heroin (60%) and methadone (40%), followed by neuroleptics (25%), anticonvul- sants (17.7%) and antidepressants (8.3%). In the chemical intoxi- cation group, acute kidney injury was registered in 15.9% of patients. The highest prevalence of acute kidney injury in this group was due to ethylene glycol (100%) and fungus poisoning (33.3%), followed by pesticides (20%) and corrosives (16.7%). With regards to RRT, there was a significantly higher prevalence in patients with psychotropic intoxication compared to chemical intoxication (p ¼0.0001). Patients intoxicated by psychotropic or chemical substances, with acute kidney injury and rhabdomyoly- sis had higher values for aspartate aminotransferase (AST), ala- nine aminotransferase (ALT), creatine phosphokinase (CPK), troponin and myoglobin. In the group with chemical intoxication, patients with acute kidney injury had higher values for AST (p ¼0.3277), ALT (p ¼0.9616) and troponin (p ¼0.0051) com- pared to those without acute kidney injury. The quantity/value of CPK (p ¼0.8348) and myoglobin (p ¼0.1127) was higher in patients with acute kidney injury intoxicated by chemical substances. Conclusion: The prevalence of acute kidney injury and necessity for RRT was significantly higher in psychotropic intoxication com- pared to chemical intoxication. Certain toxic agents in acutely intoxicated patients with rhabdomyolysis may have an important role in the development of acute kidney injury. Patients with acute kidney injury and rhabdomyolysis as well as those intoxi- cated with psychotropic substances have significantly higher 564 EAPCCT 2021 ABSTRACTS values for CPK, AST, ALT, troponin, and myoglobin compared to values for CPK, AST, ALT, troponin, and myoglobin compared to those without acute kidney injury.