钙蛋白中毒伴双峰大量肌红蛋白血症、急性肾损伤和显著降钙素原升高与败血症无关。

Q4 Biochemistry, Genetics and Molecular Biology Prague medical report Pub Date : 2022-01-01 DOI:10.14712/23362936.2022.25
Eva Svobodová, Tomáš Drábek, Helena Brodská
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引用次数: 1

摘要

服用甲基苯丙胺样物质的患者可能出现肌红蛋白尿,但很少需要住院。一名18岁的女性因服用甲基苯丙胺衍生物pervitin中毒而入院。她表现为精神状态改变,发烧,心跳和呼吸频率加快。生物标志物显示白细胞增多和降钙素原水平明显升高,提示败血症。然而,血液培养和传染病检查没有揭示。临床表现为横纹肌溶解和肌红蛋白尿,导致多器官功能衰竭,包括需要机械通气的呼吸衰竭,需要肌力支持的血流动力学损害,以及需要肾脏替代治疗的急性肾功能衰竭。令人惊讶的是,在短暂的改善后,在住院第5天观察到肌红蛋白意外的第二次高峰,通过加强消除方法和服用丹曲林来控制。急性肾损伤15天痊愈,22天出院。虽然大多数中毒患者在急诊24小时内出院而没有入院,但我们的病例报告强调,器官损伤可能发展超过通常的观察期,传统的肾脏替代疗法可能不足以减轻肌红蛋白血症导致的急性肾损伤,并且降钙素原可能不是药物性横纹肌溶解感染的可靠生物标志物。
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Pervitin Intoxication with Two-peak Massive Myoglobinemia, Acute Kidney Injury and Marked Procalcitonin Increase Not Associated with Sepsis.

Patients intoxicated with methamphetamine-like substances may present with myoglobinuria but rarely require admission. An 18-year-old female was admitted due to intoxication with pervitin, a methamphetamine derivative. She presented with an altered mental status, fever, and increased heart and respiratory rates. Biomarkers showed leukocytosis and markedly increased procalcitonin levels, suggestive of sepsis. However, blood cultures and infectious disease workup were unrevealing. Clinical course was heralded by rhabdomyolysis and myoglobinuria resulting in multi-organ failure including respiratory failure necessitating mechanical ventilation, hemodynamic compromise with need for inotropic support, and an acute renal failure requiring renal replacement therapy. Surprisingly, after a transient improvement, an unexpected second peak of myoglobin was observed on hospital day 5, controlled by intensifying the elimination methods, and administration of dantrolene. Acute kidney injury resolved by hospital day 15, and the patient could be discharged on day 22. While most patients with intoxications are discharged within 24 hours from emergency departments without being admitted, our case report highlights that the organ injury may evolve beyond the usual observation period, traditional renal-replacement therapies may not be sufficient to mitigate myoglobinemia with resulting acute kidney injury, and that procalcitonin may not be a reliable biomarker of infection in the setting of drug-induced rhabdomyolysis.

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Prague medical report
Prague medical report Medicine-Medicine (all)
CiteScore
1.10
自引率
0.00%
发文量
19
审稿时长
20 weeks
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