Rhabdomyolysis: an unusual complication following diclofenac and amitraz consumption

Amitraz is a pesticide with central alpha 2 agonistic action and diclofenac is a non- steroidal anti-inflammatory drug. Rhabdomyolysis is not commonly associated with either compound consumption. We report the case of a 28-year-old male who after presenting to us following 25ml of amitraz consumption, developed diffuse myalgia, muscle tenderness, cola coloured urine with oliguric acute renal failure which was followed by altered sensorium. Further probing revealed that he had also consumed 10 tablets of unknown dose of tablet diclofenac along with the amitraz. Rhabdomyolysis was suspected which was confirmed by an elevated creatinine phosphokinase. He was hydrated with IV fluids, given bicarbonate and N-acetylcysteine and in view of deteriorating renal function underwent 6 sessions of hemodialysis. Following the same, sensorium improved, urine output normalised, renal function improved and creatinine phosphokinase levels showed a decreasing trend indicating a reduction of the rhabdomyolysis. In poisoning cases it is often difficult to reliably confirm the drug consumed at the time of presentation. Therefore, like in our case, in addition to initial supportive measures, a periodic review of history, examination, regular monitoring of vitals and timely appropriate blood investigations can help confirm the nature of the poison and detect early the possible complications, and thus enable the early initiation of life saving treatment with improved patient outcomes.

Acute kidney injury requiring renal replacement therapy due to severe hemolysis after mechanical thrombectomy

Deep vein thrombosis is a frequently encountered medical condition, and one that is associated with significant morbidity if not promptly diagnosed and treated. Anticoagulation alone is, at times, insufficient for recanalization, particularly in those patients with ileofemoral thromboses. Pharmacomechanical catheter-directed thrombolysis has been used for clot dissolution and removal in these cases. Although hemolysis could occur due to mechanical lysis of red blood cells during the procedure, acute kidney injury has seldom been reported. We now report a case of massive hemoglobinuria that occurred immediately after the use of a pharmacomechanical catheter-directed technique to dissolve large deep vein thrombi. Severe oliguric acute renal failure ensued, complicated by uremic pericarditis and requiring four sessions of hemodialysis therapy.

Early continuous dialysis in acute glyphosate-surfactant poisoning

Introduction. Treating severe acute glyphosate-surfactant poisoning requires intensive therapy including dialysis. Cases of hemoperfusion and hemodialysis use in renal failure induced by herbicide ingestion have been reported in the current medical literature. We present a case report of successful patient treatment with continuous venovenous hemodiafiltration in acute glyphosate-surfactant poisoning. Case Outline. A 36-year-old male patient attempted suicide by drinking approximately 300 ml of glyphosate-surfactant about an hour before coming to our Clinic. On admittance the patient was somnolent, normotensive, acidotic and hyperkalemic. Six hours after poison ingestion there was no positive response to symptomatic and supportive therapy measures. The patient became hypotensive, hypoxic with oliguric acute renal failure, so that post-dilution continuous veno-venous hemodiafiltration was started. During the treatment the patient became hemodinamically stabile, diuresis was established along with electrolyte and acid-base status correction and a gradual decrease of blood urea nitrogen and creatinine levels. After a single 27.5-hour treatment, clinical condition and renal function parameters did not require further dialysis. Complete recovery of renal function was achieved on the fifth day. Conclusion. Early introduction of continuous veno-venous hemodiafiltration with other intensive therapy measures led to complete recovery in a hemodinamically instable patient.