Methamphetamine abuse and rhabdomyolysis in the ED: A 5-year study

Patients with methamphetamine toxicity are presenting in greater numbers ea ch year to emergency departments (ED) in the US. These patients are frequen tly agitated, violent, and often require physical and chemical restraint. T he incidence! and risk of rhabdomyolysis in this subpopulation is unknown. We conducted a 5-year retrospective review of all ED patients who received the final diagnosis of rhabdomyolysis. Patients with toxicology screens pos itive for methamphetamine were identified, and demographics, laboratory res ults, resource utilization, disposition, and outcome were compared to the r emaining patients. Of the total 367 patients identified, 166 (43%) were tox icology positive for methamphetamine, Methamphetamine patients differed sig nificantly from nonmethamphetamine patients with regard to demographics and hospital utilization. Methamphetamine patients had significantly higher me an initial creatine phosphokinase (CK), 12,439 U/L versus 5,678 U/L (P = 0. 02), and lower mean peak CK, 16,827 U/L versus 19,426 U/L (P = 0.03). The d evelopment of acute renal failure was not significantly different between t he 2 groups. There were 16 total deaths in the study population, 11 from co ncomitant infection/sepsis, An association between methamphetamine abuse an d rhabdomyolysis may exist, and CK should be measured in the ED as a screen for potential muscle injury in this subpopulation. Patients with rhabdomyo lysis with an unclear cause should be screened for methamphetamine or other illicit drugs. (Am J Emerg Med 1999;17:681-685. Copyright (C) 1999 by W.B. Saunders Company).