Opiate-induced Rhabdomyolysis

Three patients with opiate self-poisoning developed acute muscle damage with elevated serum aspartate aminotransferase and creatine kinase activities, increased serum myoglobin concentrations, raised plasma creatinine concentrations, hypocalcaemia and hyperphosphataemia. These abnormalities gradually resolved over 7-10 days, but recovery was complicated due to the development of acute renal failure (requiring haemodialysis) in one patient. Plasma drug concentrations, shortly after admission, in the patients taking dihydrocodeine and morphine were grossly elevated (184 and 60 μg/l respectively). Clinical evidence of myopathy was minimal in all three patients and muscle biopsy of one patient was normal at 7 days.

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Immunoassays for serum and urine myoglobin: myoglobin clearance assessed as a risk factor for acute renal failure

Clinical Chemistry ◽

10.1093/clinchem/40.5.796 ◽

1994 ◽

Vol 40 (5) ◽

pp. 796-802 ◽

Cited By ~ 52

Author(s):

A H Wu ◽

I Laios ◽

S Green ◽

T G Gornet ◽

S S Wong ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Prophylactic Treatment ◽

Clinical Evidence ◽

Kidney Dysfunction ◽

Acute Trauma ◽

Urine Specimens ◽

Low Serum ◽

Serum And Urine ◽

Serum Myoglobin

Abstract We compared four immunoassays for serum and urine myoglobin. Within-run CVs were 5-13%, with biases seen between assays. Myoglobin was stable for 1 month in serum and 12 days in urine when the pH was adjusted to between 8.0 and 9.5. Hemoglobin caused no interference. We assayed 91 pairs of serum and timed urine specimens from 41 patients admitted for acute trauma or rhabdomyolysis. Most were treated with mannitol and alkalinization. Upon initial presentations, 21 patients with either low serum myoglobin concentrations (< 400 micrograms/L) or high myoglobin clearances (> or = 4 mL/min) had normal creatinine clearances and no clinical evidence of renal disease. The remaining 20 had low myoglobin clearances. Seven were in rhabdomyolysis-induced acute renal failure, or subsequently developed this complication. We suggest that low myoglobin clearance may indicate a high risk for developing renal failure or may be an early marker for kidney dysfunction. Low myoglobin clearance may prove useful in indicating failure of prophylactic treatment to clear myoglobin.

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Impact of hepatitis C and liver fibrosis on antiretroviral plasma drug concentrations in HIV-HCV co-infected patients: the HEPADOSE study

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkq320 ◽

2010 ◽

Vol 65 (11) ◽

pp. 2445-2449 ◽

Cited By ~ 14

Author(s):

S. Dominguez ◽

J. Ghosn ◽

G. Peytavin ◽

M. Guiguet ◽

R. Tubiana ◽

...

Keyword(s):

Hepatitis C ◽

Liver Fibrosis ◽

Plasma Drug ◽

Drug Concentrations ◽

Plasma Drug Concentrations

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Clinical responses and plasma drug concentrations associated with different infusions of xylazine and ketamine in horses

Veterinary Anaesthesia and Analgesia ◽

10.1046/j.1467-2995.2000.00008-9.x ◽

2000 ◽

Vol 27 (1) ◽

pp. 58-59

Author(s):

KR Mama ◽

AE Wagner ◽

EP Steffey ◽

C Kollias-Baker ◽

PW Hellyer ◽

...

Keyword(s):

Plasma Drug ◽

Drug Concentrations ◽

Clinical Responses ◽

Plasma Drug Concentrations

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Seven-Digit Creatine Kinase in Acute Rhabdomyolysis in a Child

Child Neurology Open ◽

10.1177/2329048x16684396 ◽

2017 ◽

Vol 4 ◽

pp. 2329048X1668439 ◽

Cited By ~ 1

Author(s):

Nuha Basheer ◽

Sirin Mneimneh ◽

Mariam Rajab

Keyword(s):

Renal Failure ◽

Creatine Kinase ◽

Acute Renal Failure ◽

Creatine Kinase Level ◽

Peak Plasma ◽

Renal Dialysis ◽

Acute Rhabdomyolysis ◽

Threatening Condition ◽

Life Threatening ◽

Plasma Creatine Kinase

Rhabdomyolysis is an acute life-threatening condition that can occur in childhood secondary to many causes. The authors report the case of a 3-year-old male child who presented with acute rhabdomyolysis. The peak plasma creatine kinase level was extremely high. The 2 main causes of rhabdomyolysis in childhood are viral myositis and trauma, which can sometimes lead to acute renal failure. The highest creatine kinase levels reported in the literature so far was a 6-digit level in 2014 case report. In this study, the authors report the case of a 7-digit creatine kinase level in a child secondary to viral myositis who did not require renal dialysis.

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Drug plasma trough concentrations during treatment with daclatasvir and sofosbuvir are associated respectively with liver impairment and with renal dysfunction in HIV/HCV co-infected patients

10.21203/rs.2.11151/v1 ◽

2019 ◽

Author(s):

Ilaria Mastrorosa ◽

Massimo Tempestilli ◽

Stefania Notari ◽

Patrizia Lorenzini ◽

Gabriele Fabbri ◽

...

Keyword(s):

Renal Dysfunction ◽

Virologic Response ◽

Patient Treatment ◽

Limited Information ◽

Plasma Drug ◽

Related Factors ◽

Immunological Parameters ◽

Liver Impairment ◽

Drug Concentrations ◽

Plasma Drug Concentrations

Abstract Background Sofosbuvir (SOF) plus daclatasvir (DCV) achieved high rates of sustained virologic response (SVR) with no difference according to HIV serostatus. Only limited information is available on the pharmacokinetics variability of SOF and DCV in HIV/HCV co-infected patients. Aim was to evaluate the association of plasma drug concentrations (Ctrough) of SOF and of DCV with patient-, treatment-, and disease-related factors in the real-world setting of HIV/HCV co-infected persons. Methods HIV/HCV co-infected patients, undergoing SOF plus DCV treatment, were prospectively enrolled. At baseline, week4 (W4), end of treatment (EOT), and after-EOT, biochemical and viro-immunological parameters were assessed. FIB-4 score and CKD-EPI equation were used for estimation of liver disease and glomerular filtration rate (eGFR), respectively. SOF, SOF metabolite (GS-331007), and DCV Ctrough were measured at W4 and week8 (W8), and the mean value (mean-Ctrough) was calculated Results Thirty-five patients were included (SVR 94%). Increasing GS-331007 mean-Ctrough significantly correlated with decreasing eGFR at W4 (rho=-0.36; p=0.037) and EOT (rho=-0.34; p=0.048). Between DCV mean-Ctrough and FIB-4, a significant correlation was observed at all time-points: baseline (rho=-0.35; p=0.037), W4 (rho=-0.44; p=0.008), EOT (rho=-0.40; p=0.023), after-EOT (rho=-0.39; p=0.028). Conclusion In HIV/HCV co-infected patients receiving SOF plus DCV, plasma drug concentrations are associated with renal dysfunction for GS-331007 and with liver impairment for DCV. Though clinical and therapeutically relevance of these findings may apparently be limited, growth of clinicians’ knowledge on DAA exposure in difficult-to-treat patients, as cirrhotic and renal impaired subjects, can be relevant in single cases.

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