D. Ardeleanu 1, 2, R. Avram 1, O. Constantinescu 3
1 Spitalul Clinic de Urgenţă Bucureşti,. Secţia de Toxicologie Clinică
2 Catedra de Toxicologie, Farmacologie Clinică şi Psihofarmacologie, UMF “Carol Davila” Bucureşti
3 Spitalul Clinic de Urgenţă Bucureşti,. Secţia de Dializă
Abstract
Introduction: Rhabdomyolysis is an acute destruction of skeletal muscle characterized by necrosis, breaking of the muscular fibres, release of myoglobin and other cell components. The clinic picture sometimes presents a dramatic aspect. The severe rhabdomyiolysis determins muscular pain and tumefaction, and the released myoglobin will determine acute renal failure. Rhabdomyolisis may be due to the direct toxic effect of ethanol as well as to the CO determined hypoxia. Clinical case : Young man, 34 year old, transferred in our department 48 hours after an acute poisoning with ethanol and accidental exposure to CO. On admitance: conscious, difusse myalgias, tumefaction at the level of lower limbs, acute renal failure with anuria, (BUN 128mg/ml, creatinine 4,88mg/ml), rhabdomyolisis ( CK 150.000 ui) and hepatic disfunction. The MRI highlights diffuse edematous and hemoragic modification at the level of the gluteal and adductor muscles supporting the diagnosis of rhabdomyolisis. An infectious pathology was excluded by specific laboratory tests. The treatment was a supportive one, concomitent with hemodyalisis sessions. During hospitalization: a CT scan rendered voluminous hemorragic modifications in the spinal, gluteal, adductor, and pectineal muscles (with severe anemia HB 4g/l ). The clinic evolution was favorable. Conclusions: Acute ethanol and Co poisoning has sometimes a severe clinic evolution with rhabdomyolisis and acute renal failure, without convulsions, by the direct toxic effect and hypoxia.