Delirium in the course of alcohol withdrawal syndrome complicated by rhabdomyolysis
Keywords:
delirium, alcohol withdrawal syndrome, rhabdomyolisis, crush syndromeAbstract
Rhabdomyolysis is characterized by the leakage of contents of muscle cells including myoglobin, creatine kinase, alanine amino-transferase and aspartate aminotransferase into the circulation. Some of these sarcoplasmic proteins, such as the myoglobin, can be directly toxic to kidney cells and it can impair and clog the filtration system of the kidney. Both mechanisms can lead to kidney failure. The most common reported causes of rhabdomyolisis are physical factors like crush injury, strenuous exercise, extensive burns, high-voltage electrical injury, status asthmaticus, tetanus, prolonged seizures or status epilepticus, acute psychosis, alcohol withdrawal syndrome. Some people have a genetic susceptibility which increases the risk of rhabdomyolysis. We present a case of 35-year-old man with rhabdomyolisis caused by psychomotor agitation directly connected with delirium caused by alcohol withdrawal. The initial symptom was the characteristic reddish-brown discoloration of the urine as a result of myoglobinuria, with concomitant increased level of myoglobin and creatine kinase (CK) in the blood. The serum myoglobin concentration increased to 3300 ng/ml, and the creatine kinase was 182000,0 U/L. An improvement of patient’s state was observed after early fluid therapy which prevented acute renal failure.
References
1. Habrat B., Zaburzenia psychiczne spowodowane przyjmowaniem środków psychoaktywnych. W: Bilikiewicz A., red. Psychiatria podręcznik. Wyd. III. Warszawa. PZWL. 2007; 11: 239-269.
2. Wasilewski D., Matsumoto H., Kur E., Dziklińska A., Woźny E., Stencka K., Skalski M., Chaba P., Szelenberger W.. Leczenie majaczenia alkoholowego przy pomocy szybkiego nasycania diazepamem. Psychiatr Pol 1995; 29: 675-686.
3. Erwin W.E., Williams D.A., Speir W.A.: Delirium tremens. So Med. J 1998, 91: 425-432.
4. Mast R.C. van der: Pathophysiology of delirium. J Geriatr Psychiatry Neurol, 1998, 11: 138-145.
5. Wojnar M., Bizoń Z., Wasilewski D., The role of somatic and physical injury in the development of alcohol withdrawal delirium. Alcohol. Clin Exp Res 1999; 23: 209–213.
6. Karch S.B., Stephens B.G., Drug abusers who die during arrest or in custody. J Royal Soc Med. 1999; 92: 110–113.
7. Park K.S., Korn C.S., Henderson S.O., Agitated delirium and sudden death: Two case reports. Prehosp Emer Care 2001; 214–216.
8. Vanholder R., Sever M.S., Erek E., Lameire N.: Rhabdomyolysis. J Am Soc Nephrol 2000; 11: 1553-1561.
9. Bywaters E.G., Beall D., Crush injuries with impairment of renal function. BMJ 1941; 1: 427-432.
10. Bywaters E.G. (1990). 50 years on: the crush syndrome. BMJ 1990; 301: 1412–1415.
11. Gabon P.A., Kaehny W.D., Kelleher S.P.,: The spectrum of rhabdomyolysis. Medicine 1982; 61: 141-152.
12. Vanholder R., Sever M.S., Erek E., Lameire N:. Acute renal failure to the crush syndrome: towards an era of seismonephrology. Nephrol Dial Transplant 2000; 15: 1517-1521.
13. Dembińska-Kieć A., Naskalski J.W., Podstawy diagnostyki laboratoryjnej z elementami biochemii klinicznej, wyd II. 2005; 17: 543-546.
14. Huerta-Alardín A.L., Varon J., Marik P.E., Bench-to-bedside review: rhabdomyolysis – an overview for clinicians. Critical Care 2005; 9: 158–169.
15. Pelonero A.L., Levenson J.L., Pandurangi A.K., Neuroleptic malignant syndrome: A review. Psychiatr Serv 1998; 49: 1163–1172.
16. Samuel E., Williams R.B., Ferrell R.B., Excited delirium: Consideration of selected medical and psychiatric issues. Neuropsychiatr Dis Treat 2009; 5: 61-66.
