Abstract
Because an increasing number of patients were arriving at our emergency room with cocaine intoxication and rhabdomyolysis, we reviewed our experience with such patients.
We identified 39 patients seen at our institution over an eight-year period with acute rhabdomyolysis after cocaine use. The patients' mean creatine kinase level was 12,187 U per liter (range, 1756 to 85,000). Thirteen of the 39 patients (33 percent) had acute renal failure; 6 of them died. In comparison to the patients with normal renal function, those with renal failure were more often admitted with profound hypotension (46 vs. 4 percent; P<0.001), hyperpyrexia (69 vs. 15 percent; P<0.001), and markedly elevated serum creatine kinase levels (mean, 28,084 vs. 7931 U per liter; P<0.01). Disseminated intravascular coagulation developed in seven patients with renal failure. All six deaths were in this group. Severe hepatic dysfunction was found in 11 patients with renal failure.
We conclude that cocaine intoxication can cause acute rhabdomyolysis with acute renal failure, severe liver dysfunction, and disseminated intravascular coagulation and that the mortality rate among patients with this syndrome is high. (N Engl J Med 1988; 319:673–7.)
THIRTY million Americans are estimated to have tried cocaine at least once, and 5 million may use it regularly.
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What was previously "social and recreational" intranasal use has escalated to frequent and habitual smoking of the alkaloid form of cocaine ("free base"). A growing literature describes the potentially life-threatening consequences of cocaine use, which result principally from its effects on the cardiovascular and central nervous systems.
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In this article we describe a series of patients with cocaine intoxication, rhabdomyolysis, and acute renal failure.
Methods
To identify patients with cocaine intoxication and rhabdomyolysis, we reviewed the computerized registry of hospital discharges . . .
