Abstract: TH-PO141
Rhabdomyolysis Associated with Aspirin-Mediated Hyperthermia
Session Information
- Drug Events Trainee Case Reports
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 103 AKI: Mechanisms
Authors
- Al jandali, Mhd hussam, Henry Ford Hospital, Detroit, Michigan, United States
- Mueller, Laurel, Henry Ford Hospital, Detroit, Michigan, United States
- Khan, Bilal shahzad azam, Henry Ford Hospital, Detroit, Michigan, United States
- Novak, James E., Henry Ford Hospital, Detroit, Michigan, United States
Introduction
Salicylate toxicity and rhabdomyolysis are both potentially life-threatening conditions. Only 2 reports have previously described an association between salicylate toxicity and rhabdomyolysis. We present a case of non-traumatic rhabdomyolysis occurring after aspirin overdose.
Case Description
A 36-year-old male with a history of chronic aspirin use (~2,600 mg daily) presented to the emergency department with dyspnea. A few hours earlier, he had taken approximately 20 tablets of aspirin (325 mg each) to treat a headache. He denied trauma. Within an hour, he developed hypoxic respiratory failure requiring intubation and mechanical ventilation. His initial salicylate level was 76.1 mg/dL. Other laboratory values on presentation included serum creatinine 2.7 mg/dL, total CO2 18 mmol/L, arterial pH 7.22, and creatine kinase (CK) 436 U/L. Pressors were initiated for worsening hypotension. The patient became hyperthermic to 41.7°C. The aspirin overdose was initially treated with intravenous sodium bicarbonate, but when the patient became anuric on hospital day 2, continuous renal replacement therapy was initiated. Evaluation of stage 3 acute kidney injury (AKI) revealed that CK increased to 28,880 U/L by hospital day 3, and then slowly returned to normal limits over the next 2 weeks. Kidney function recovered sufficiently to stop hemodialysis on hospital day 27.
Discussion
Two cases, published in 1989 and 1994, describe rhabdomyolysis and AKI in patients presenting with acute aspirin overdose. Both cases describe patients with hyperthermia, attributed to aspirin-mediated mitochondrial toxicity, followed by rhabdomyolysis. A case report from 2016 describes a young patient presenting with temperature 41.1°C, CK 57,050 U/L, and AKI after use of K2, a synthetic cannabinoid. Exertional hyperthermia is a well-known cause of rhabdomyolysis, but drug-induced hyperthermia is less frequently described. High fever may be an important link between aspirin overdose and rhabdomyolysis.