Severity and outcome in acutely intoxicated patients with elevated creatine kinase

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.