[Rhabdomyolysis, disseminated intravascular coagulation and acute renal failure after severe narcotics intoxication (MDMA, THC, amphetamine)].
More often we are faced with the cases of young people (who are in a serious condition) who land in ICU, because of severe narcotics intoxication, which they took occasionally on the concerts, discotheques and social events. From 1997 we observed rapid increase of admission to hospitals due to amphetamine, MDMA (2,3-methylenedeoxymethamphetamine which is a main component of a tablet called ecstasy) and THC (9-d tetrahydrocannabinols which are a component of sunn hemps) intoxication and decrease of opioid's poisoning. 23 years old patient was admitted to ICU in critical condition after severe narcotics intoxication. Patient was deeply unconscious (GCS 3) with tetraplegia and high temperature (39.6 degrees C). He had endotracheal tube (artificially ventilated) and hypovolemic shock with circulatory insufficiency (blood pressure was supported by 3 catecholamines). We observed many petechias and ecchymoses which suggested vascular haemorrhagic diathesis. It was found that the patient had disseminated intravascular coagulation and rhabdomyolysis with acute renal failure which was treated by dialysis. After 26 days of intensive treatment the patient was conscious, he had also efficient circulatory and respiratory system but with slight improvement of neurological state. In this condition he was admitted on nephrology ward to continue the treatment and start rehabilitation. The presence of high concentration of amphetamine, MDMA and THC in blood, extreme dehydration and electrolytes disturbances caused rhabdomyolysis, DIC syndrome and acute renal failure which make the prognosis worse and complicate the treatment. Estimating probability of death of this patient in SAPS II scale (Simplified Acute Physiology Scale) he has bad prognosis (86 points gives 95% of death probability). The patient is alive (what is a big success), probably thanks to quick arrival to specialized medical centre and dialysis treatment which was started early.
Kunsdorf-Wnuk
Anna
A
Katedra i Klinika Anestezjologii i Intensywnej Terapii Slaskiej Akademii Medycznej, Katowicach. akunsdorf@poczta.clinika.pl
Musioł
Ewa
E
Karpel
Ewa
E
Arct-Danielak
Danuta
D
D058186:Acute Kidney Injury / Q000139:chemically induced*; D000328:Adult; D000661:Amphetamine / Q000009:adverse effects*; D000697:Central Nervous System Stimulants / Q000009:adverse effects; D003606:Dacarbazine / Q000737:chemistry*; D013759:Dronabinol / Q000009:adverse effects*; D006213:Hallucinogens / Q000009:adverse effects; D006801:Humans; D008297:Male; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000009:adverse effects*; D012206:Rhabdomyolysis / Q000139:chemically induced*
D000697:Central Nervous System Stimulants; D006213:Hallucinogens; D003606:Dacarbazine; D013759:Dronabinol; D000661:Amphetamine; D018817:N-Methyl-3,4-methylenedioxyamphetamine