title: Acute renal failure after ingestion of guaifenesin and dextromethorphan.
abstract: BACKGROUND
  Guaifenesin is a common nonprescription medication that has been implicated in drug-induced nephrolithiasis. Dextromethorphan, a nonprescription antitussive found in some guaifenesin-containing preparations, is increasingly recognized as a substance of abuse by many youth and young adults. Renally excreted medications known to have poor solubility in urine have the potential to precipitate when ingested in large quantity, leading to acute obstruction of the ureters and renal failure.
  
  
  OBJECTIVE
  We describe the case of a 22-year-old male who developed severe bilateral flank pain, hematuria, and oliguria after an isolated recreational ingestion of guaifenesin and dextromethorphan.
  
  
  METHODS
  The patient was found to have bilateral ureteral obstruction and acute renal failure, suspected to be secondary to precipitation of medication metabolites in the urine.
  
  
  CONCLUSIONS
  This case highlights the potential for acute renal failure secondary to guaifenesin and dextromethorphan abuse.
authors.affiliation: Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Evan
authors.initials: E
authors.lastname: Small
authors.affiliation: Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Sandefur
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000996:Antitussive Agents / Q000009:adverse effects; D003915:Dextromethorphan / Q000009:adverse effects; D005100:Expectorants / Q000009:adverse effects*; D006140:Guaifenesin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D019966:Substance-Related Disorders / Q000150:complications; D014517:Ureteral Obstruction / Q000139:chemically induced* / Q000628:therapy; D055815:Young Adult
chemical_list: D000996:Antitussive Agents; D005100:Expectorants; D006140:Guaifenesin; D003915:Dextromethorphan
keywords: dextromethorphan; guaifenesin; renal failure; ureteral calculi/medication induced; ureteral obstruction