Severity and outcome in acutely intoxicated patients with elevated creatine kinase
Journal
Clinical Toxicology
Date Issued
2023-05
Author(s)
Bekjarovski, Niko
Jurukov, Irena
Berat Huseini, Afrodita
Naumovski, Kiril
DOI
https://doi.org/10.1080/15563650.2023.2192024
Abstract
Objective: Rhabdomyolysis is a clinical entity characterized by
the release of intracellular enzymatic content from skeletal
muscle into the bloodstream that leads to systemic complications. We determine the causes of mortality in patients with
rhabdomyolysis following acute intoxication with psychotropic
and chemical substances.
Methods: This was a prospective clinical study, which included
140 patients with rhabdomyolysis divided into two groups
depending on the substance taken, psychotropic or chemical
intoxications. The severity of rhabdomyolysis was assessed
according to the Poison Severity Score. Patients were divided
into 3 groups a) mild rhabdomyolysis, CPK level from 250 to
1,500 U/L); b) moderate rhabdomyolysis CPK level from 1,500 to
10,000 U/L) and c) severe rhabdomyolysis CPK greater than
10,000 U/L. We included adult patients ages 18 and older with
rhabdomyolysis in the study. They had been acutely intoxicated
with either psychotropic or chemical substances within 48 hours
prior to hospital admission.
Results: In the group with psychotropic intoxications, the level
of CPK on the first day in patients with a fatal outcome was significantly higher (p ¼ 0.0242) compared to survivors. In the chemical intoxication group, the patients with fatal outcomes
compared to survivors had lower CPK levels on the first day, but
this difference was not significant (p ¼ 0.2747 versus p ¼ 0.5779).
Mortality was registered in a total of 9.3% (n ¼ 13) patients with
rhabdomyolysis, of which 23.1% (n ¼ 3) had psychotropic intoxication and 76.9% (n ¼ 10) chemical intoxication. The analysis indicated a significantly lower mortality in psychotropic compared to
chemical intoxications (p ¼ 0.0001). Mortality in the group of psychotropic intoxications, according to the etiological cause was
highest with methadone at 13.3% (n ¼ 2), and neuroleptics at
8.3% (n ¼ 1). In the chemical intoxication group, the prevalence
of mortality according to the etiological cause was highest in
patients intoxicated with herbicides 50% (n ¼ 1), ethylene glycol
33.3% (n ¼ 1), corrosives 33.3% (n ¼ 4) and organophosphates
26.7% (n ¼ 4).
Conclusion: Rhabdomyolysis had no significant effect on the
fatal outcome in acutely intoxicated patients with psychotropic
and chemical substances. Mortality was significantly lower in
patients with rhabdomyolysis intoxicated with psychotropic
drugs compared to chemical intoxications. In patients intoxicated
with chemical substances, which were mild or moderate rhabdomyolysis, the causes of death were corrosive agents, ethylene
glycol, herbicides, and organophosphates. The fatal outcome was
due to the toxic effects of these agents and the severe disorders
they cause.
the release of intracellular enzymatic content from skeletal
muscle into the bloodstream that leads to systemic complications. We determine the causes of mortality in patients with
rhabdomyolysis following acute intoxication with psychotropic
and chemical substances.
Methods: This was a prospective clinical study, which included
140 patients with rhabdomyolysis divided into two groups
depending on the substance taken, psychotropic or chemical
intoxications. The severity of rhabdomyolysis was assessed
according to the Poison Severity Score. Patients were divided
into 3 groups a) mild rhabdomyolysis, CPK level from 250 to
1,500 U/L); b) moderate rhabdomyolysis CPK level from 1,500 to
10,000 U/L) and c) severe rhabdomyolysis CPK greater than
10,000 U/L. We included adult patients ages 18 and older with
rhabdomyolysis in the study. They had been acutely intoxicated
with either psychotropic or chemical substances within 48 hours
prior to hospital admission.
Results: In the group with psychotropic intoxications, the level
of CPK on the first day in patients with a fatal outcome was significantly higher (p ¼ 0.0242) compared to survivors. In the chemical intoxication group, the patients with fatal outcomes
compared to survivors had lower CPK levels on the first day, but
this difference was not significant (p ¼ 0.2747 versus p ¼ 0.5779).
Mortality was registered in a total of 9.3% (n ¼ 13) patients with
rhabdomyolysis, of which 23.1% (n ¼ 3) had psychotropic intoxication and 76.9% (n ¼ 10) chemical intoxication. The analysis indicated a significantly lower mortality in psychotropic compared to
chemical intoxications (p ¼ 0.0001). Mortality in the group of psychotropic intoxications, according to the etiological cause was
highest with methadone at 13.3% (n ¼ 2), and neuroleptics at
8.3% (n ¼ 1). In the chemical intoxication group, the prevalence
of mortality according to the etiological cause was highest in
patients intoxicated with herbicides 50% (n ¼ 1), ethylene glycol
33.3% (n ¼ 1), corrosives 33.3% (n ¼ 4) and organophosphates
26.7% (n ¼ 4).
Conclusion: Rhabdomyolysis had no significant effect on the
fatal outcome in acutely intoxicated patients with psychotropic
and chemical substances. Mortality was significantly lower in
patients with rhabdomyolysis intoxicated with psychotropic
drugs compared to chemical intoxications. In patients intoxicated
with chemical substances, which were mild or moderate rhabdomyolysis, the causes of death were corrosive agents, ethylene
glycol, herbicides, and organophosphates. The fatal outcome was
due to the toxic effects of these agents and the severe disorders
they cause.
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