COCAINE-ASSOCIATED RHABDOMYOLYSIS CAUSING RENAL-FAILURE IN PREGNANCY

Background: Cocaine use is known to have multisystemic effects. Recent ly, acute renal failure as a result of rhabdomyolysis has been describ ed as a complication of cocaine use. During pregnancy, cocaine is asso ciated with abruptio placentae. A patient presenting with both complic ations is described. Case: A 25-year-old multiparous woman at 34 weeks ' gestation developed abruptio placentae approximately 18 hours after using cocaine alkaloid. Six hours later, a cesarean delivery was perfo rmed after she presented with vaginal bleeding and fetal bradycardia. Oliguria was present from admission and persisted despite aggressive f luid hydration, dopamine infusion, and intravenous administration of f urosemide. Serum creatinine phosphokinase and urine myoglobin were bot h elevated at 558 IU/L and 432 ng/mL. Hemodialysis was required for pr esumed cortical necrosis. Conclusion: Rhabdomyolysis, as indicated by elevated creatinine phosphokinase and the presence of myoglobin in the urine, suggests that nephrotoxicity from myoglobinuria may contribute to acute renal failure in cases of cocaine mediated abruptio placenta e.