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(594) Rhabdomyolysis in Combative or Intoxicated Emergency Department Patients


Authors:

Mikhail Blyakher, n/a – Resident, Rutgers New Jersey Medical School

Mariya Cherneykina, n/a – Resident Physician, Rutgers New Jersey Medical School

Christine Ramdin, PhD, n/a – Research Associate, Rutgers New Jersey Medical School

Michael Anana, MD – Assistant Professor, Rutgers New Jersey Medical School

Michael Anana, MD – Assistant Professor, Rutgers New Jersey Medical School

Abstract:

Background and Objectives: Rhabdomyolysis is an urgent condition that can result in acute kidney injury (AKI), renal failure and death. There are mixed data on the utility of the diagnostic criteria (creatine kinase (CK) greater than 5000 U/L) for rhabdomyolysis. Patients with CK levels less than 5000 U/L may suffer adverse sequelae, while those with even markedly elevated levels of CK often do not. Agitated and intoxicated patients are often screened for rhabdomyolysis in emergency departments (EDs), yet there are no data on the prevalence of rhabdomyolysis-induced kidney injury, dialysis requirements, and mortality.

Methods: We conducted a retrospective chart review of adult (≥ 18 years of age) patients from January 2015 to December 2017 diagnosed with drug intoxication, alcohol intoxication, overdose, combative behavior, aggressive behavior, and behavioral problems who had CK levels drawn. Patients were excluded if they had ESRD or signed out against medical advice. Patients were divided into three groups based on maximal measured CK values. CK < 1000 (Group 1); CK between 1000-5000 (Group 2); CK greater than 5000 (Group 3). The rate of AKI (defined as a 1.5x increase in initial to maximal creatinine), dialysis, mortality, and 30-day return for kidney-related injury were measured for each group.

Results: 492 patients were included. In Group 1, 1/389 (0.003, 95% CI 0.0001-0.017) patients had AKI, 0/389 (0, 95% CI 0-0.0122) required dialysis. In Group 2, 2/84 (0.024, 95% CI 0.004-0.091) patients had AKI, 0/84 (0, 95% CI 0-0.055) required dialysis. In Group 3, 3/19 (0.16, 95% CI 0.042-0.405) patients had AKI, 2/19 (0.11, 95% CI 0.019-0.35) required dialysis. There were no deaths or 30-day return visits in all groups.

Conclusion: Of patients who presented to the ED for agitation or intoxication, the majority had CK 5000 U/L) had a significantly higher incidence of AKI and renal failure compared to Group 1 (CK <5000 U/L). Further research is needed to determine what clinical findings are associated with CK values greater than 5000 to better determine which subset of intoxicated or agitated patients need to be screened for rhabdomyolysis.

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