Rhabdomyolysis is a common condition with potentially devastating complications, and only few therapeutic options are available for the treatment of acute Rhabdomyolysis. In this case, a 56-year-old male who had been drinking alcohol, presented to the emergency department for evaluation of slurred speech, ataxic gait, mood instability, and cognitive disorder. On admission, his creatine kinase (CK) level was 2882 U/L. Despite aggressive fluid repletion, his CK level continued to increase, peaking at 11350 U/L. On administration and after the fluid transfusion with isotonic saline, his CK levels and clinical symptoms improved dramatically. We report this case as it is a rare condition of Rhabdomyolysis due to alcohol, with the intent to highlight its clinical features and paraclinical finding.

Statins are commonly used drugs in the treatment of hyperlipidemia (HL), despite some undesirable side effects. These range from mild symptoms such as myopathy, muscle weakness and myalgia to severe muscle weakness associated with chronic myopathy and acute renal failure (ARF) as a result of Rhabdomyolysis. The most serious and deadly side effect of statins is Rhabdomyolysis. The case presented here is of a patient with Rhabdomyolysis due to treatment with the antihyperlipidemic drug, atorvastatin.

Introduction: Some studies have reported creatinine phosphokinase (CPK) as a new emergingway in predicting the outcomes of poisoned patients. This study aimed to evaluate the association of serum CPK level in the first 24 hours with outcomes of poisoned patients. Methods: This retrospective cross-sectional study was performed using the medical profiles of poisoned patients aged between 13 and 70 years old who were referred to the emergency department of a big referral medical toxicology center during 6 years and whose necessary data for this study was available. Results: 318 patients with the mean age of 34. 9§ 14. 5 years were studied (77. 1% male). The mean serum CPK level of patients was 4693. 1 § 10303. 8 (35– 89480) IU/L. There was no significant correlation between serum CPK level and cause of poisoning (r= 0. 16; p=0. 51), age (r =-0. 021; p = 0. 651), sex (r = 0. 131; p = 0. 281), seizure (r =-0. 022; p = 0. 193), level of consciences (r =-0. 138; p = 0. 167), and duration of hospital stay (r= 0. 242, p = 0. 437). The mean serum CPK level was significantly higher in ICU admitted (p<0. 0001), AKI (p<0. 0001), hyperkalemia (p<0. 0001), hypophosphatemia (p=0. 045), and hypocalcaemia (p=0. 008) cases. The best cut off point of serum CPK level in predicting acute kidney injury (AKI) was estimated to be 10000 IU/L (sensitivity = 83. 8% and specificity = 68. 8%). Conclusion: It seems that CPK could be considered as a candidate tool for screening the intoxicated patients in need for ICU admission and at risk for AKI.

In the natural disasters such as earthquake, based on severity of trauma, time under the rubble and quality/quantity of hydratation we will confront with a spectrum of traumatic Rhabdomyolysis. In present study we evaluate victims of Bam earthquake to show different stage of muscle trauma, from minor trauma with almost normal level of muscle enzyme to those with moderate trauma leading to crush injury and finally to advanced crush syndrome. Questionnaire consisted of clinical, biochemical and demographic items was designed and completed by our research team retrospectively. We divided the patients to crush and non-crush and also crush injury and crush syndrome, and then compared aforementioned items between them. Clinical and laboratory data of 2962 hospitalized victims, with an average age of 28.4(SD14.2) years (range 1-90) were collected (40% female). 611 patients were affected with crush injury (20%). These were entrapped 2.2 hours longer than the others (P<0.001). Mean IV intake in first 5 days was 3.6(SD2.6) liters for these patients in compare with 2.5(SD1.4) liters for others (P<0.001). 200 cases showed complete feature of crush syndrome. Electrolyte imbalance and systemic complications were drastically increased in the worst patients with crush syndrome. In approach to crushed patients of natural disasters by attention to the wide spectrum of muscle damage and systemic problems, the stepwise management protocol based on severity of traumatic Rhabdomyolysis is inevitable and warranted.

To the Editor;Tramadol, a synthetic opioid is mainly used to treat acute and chronic pain. Although this drug is not an over-the-counter medication, it has been illicitly accessible to and abused by opium addicts. Studies showed excessive and widespread use of tramadol in Iran. Tramadol may cause constipation, drowsiness, tachycardia and respiratory distress, while the most severe complications of tramadol overdose include refractory seizures, Rhabdomyolysis and renal failure. These serious complications may occur in sequence in tramadol overdose, as seizure can induce Rhabdomyolysis, and renal failure mostly results from Rhabdomyolysis (2,3). It has been reported that seizure develops in approximately one-third of cases with tramadol overdose (1,3,4).

Background and Objectives: Succinylcholine is the only depolarizing neuromuscular blocker available which has been used for more than 50 years in the emergency cases, rapid sequence induction, and when aspiration treated as a risk factor. Unlike the nondepolarizing neuromuscular blockers, Succinylcholine has rapid time-to-onset of action and short duration of action. However, there are a number of potential side effects associated with succinylcholine. Case Report: A thirty-year old women was settled in cesarean ward under general anesthesia in Rafsanjan Niknafs hospital in 2007. Patient begun to breath after closing the volatile agent s and administration of reversal drugs, but she was not able to raise her head. Despite second reverse injection, after 30 minutes, her breathing was not adequate. Gradually, her body temperature increased up to 37.9°C and urine color turned to brown. Dantrolene infusion was started and patient was transferred to ICU. Tracheal intubated and oxygenation was done by ventilator because of respiration muscular weakness. Weaning of ventilator was performed after 7 days, and three days later the patient was discharged.Conclusion: Anesthesiologist should be aware of potential side effects of succinylcholine and be prepared to manage it. Consideration of rapid action non-depolarising neuromuscular blocking drugs in the prevention of these types of complications is useful.

Background: Rhabdomyolysis is one of the major complications of poisoning caused by alcohol, narcotics, and psychotropic substances acute toxicity, which might lead to acute renal failure and even death. This study aimed to evaluate clinical and laboratory findings of Rhabdomyolysis syndrome in poisoning patients who were admitted to poisoning ward of Farshchian Hospital of Hamadan, Iran.Methods: In this cross-sectional study, patients with acute toxicity by alcohol, narcotics, or psychotropic drugs who were admitted in poisoning ward of Farshchian Hospital of Hamadan were investigated during a 6-month period in 2012. Clinical and laboratory data were collected by a standard questionnaire and analyzed by the SPSS software version 16.Results: Eighty-two patients aged between 14 to 81 years were investigated. Twentytwo cases developed Rhabdomyolysis and narcotics related toxicity was the most common cause. The most common clinical symptom in all patients was muscle pain (51cases, Laboratory studies showed some significant differences between serum creatine kinase (CK), lactate dehydrogenase (LDH), serum creatinine, and aminotransferases (AST, ALT) levels in Rhabdomyolysis cases as compared to the others (p<0.05).Conclusion: The results of this study revealed that the incidence of Rhabdomyolysis syndrome in acute intoxication with alcohol and narcotics is significant and without proper treatment might cause serious complications such as acute renal failure and even death. Classic clinical signs and symptoms of Rhabdomyolysis are usually not present simultaneously, thus strong clinical suspicion and proper laboratory tests have important role in early diagnosis and suitable treatment. Laboratory studies have an important role in the diagnosis of this syndrome.