Abstract: PUB001
A Rhabdomyolysis, a Methemoglobinemia, and a Death
Session Information
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Kutlu, Özgür Timuçin, TC Saglik Bakanligi Isparta Sehir Hastanesi, Isparta, Isparta Province, Turkey
- Avci, Muammer, TC Saglik Bakanligi Isparta Sehir Hastanesi, Isparta, Isparta Province, Turkey
Introduction
Although metoclopramide is generally well tolerated, it may cause adverse effects involving multiple organ systems. Methemoglobinemia is a very rare clinical condition; however, when not recognized and treated promptly, it may result in death.
Case Description
A 26-year-old male soldier presented to the military infirmary with generalized body pain and received intramuscular diclofenac sodium as an analgesic. Subsequently, he developed worsening diffuse muscle pain and difficulty urinating and was admitted to our emergency department. History, physical examination, and laboratory investigations revealed a history of intense exercise one week earlier, followed by analgesic use, accompanied by acute elevation of liver enzymes and acute kidney injury. The patient was therefore admitted to the internal medicine intensive care unit.
Due to anuria, hemodialysis therapy was initiated. Because of persistent nausea, intravenous metoclopramide was administered at a dose of 10 mg three times daily. Despite intermittent hemodialysis sessions, the patient remained anuric, and his clinical condition progressively deteriorated. Bradycardia and intermittent episodes of altered consciousness developed. Oxygen saturation measured by pulse oximetry in the intensive care unit was in the 70% range. Arterial blood gas analysis demonstrated a markedly elevated methemoglobin level (FMetHb: 38.1%).
As the patient exhibited dyspnea and worsening hypoxemia, emergency treatment was initiated with intravenous methylene blue and vitamin C after urgent procurement of the medication. However, his clinical condition continued to deteriorate, necessitating endotracheal intubation. The patient was subsequently transferred to a military hospital, where plasmapheresis and hyperbaric oxygen therapy were administered. Despite these interventions, the patient did not respond to treatment and eventually died.
Discussion
We present this case to highlight metoclopramide as a rare but potentially fatal cause of hypoxemia and methemoglobinemia in a young soldier who developed acute kidney injury following rhabdomyolysis after intense exercise and subsequently received metoclopramide for nausea.
Acknowledgment
I would like to thank the congress team very much for giving me the opportunity to present this presentation.