title: Rhabdomyolysis and acute renal failure following an overdose of doxepine and nitrazepam.
abstract: A 50-year-old woman developed rhabdomyolysis and myoglobinuric renal impairment after an oral dose of 250 mg nitrazepam and 1,250 mg doxepin. Serum creatinine increased from 70 mumol/l to 472 mumol/l in two days. Serum creatine phosphokinase reached a maximal level of 391 mu kat/l (reference range less than 2.5 mu kat/l) on the third day and serum myoglobin was maximally 910 nmol/l (reference range less than 4.5 nmol/l) on the fourth day after the overdose. Passive and active movements of the knees and ankles became increasingly restricted, but the patient felt no muscle pain. Diuresis decreased to 20-22 ml/hour in spite of repetitive doses of furosemide, but was enforced to greater than 100 ml/hour by vigorous infusion of saline. Haemodialysis was avoided on this regimen. It is suggested that in patients intoxicated with nitrazepam and/or doxepin, rhabdomyolysis should be suspected when a rapidly increasing serum concentration of creatinine is found, even in the absence of muscle pain.
authors.affiliation: Department of Internal Medicine C, Aalborg Hospital, Denmark.
authors.forename: A D
authors.initials: AD
authors.lastname: Højgaard
authors.forename: P T
authors.initials: PT
authors.lastname: Andersen
authors.forename: J
authors.initials: J
authors.lastname: Møller-Petersen
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced*; D003402:Creatine Kinase / Q000097:blood; D003404:Creatinine / Q000097:blood; D004316:Doxepin / Q000506:poisoning*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009211:Myoglobin / Q000097:blood; D009567:Nitrazepam / Q000506:poisoning*; D009846:Oliguria / Q000139:chemically induced; D012206:Rhabdomyolysis / Q000097:blood / Q000139:chemically induced*
chemical_list: D009211:Myoglobin; D004316:Doxepin; D009567:Nitrazepam; D003404:Creatinine; D003402:Creatine Kinase