A51-40 Muscle Meltdown: Chronic Alcohol Use and Rhabdomyolysis

Abstract Introduction Rhabdomyolysis is a syndrome characterized by muscle necrosis and release of intracellular muscle contents into the bloodstream, often classified as traumatic or non-traumatic. Chronic alcohol abuse is often overlooked as a cause of non-traumatic rhabdomyolysis. We present a case of alcohol withdrawal, complicated by rhabdomyolysis and acute renal failure. Case A 64 year old male with a history of chronic alcohol use disorder was brought by police to the ED for psychomotor agitation. Initial vitals included HR 111 beats per minute and blood pressure of 165/91 mmHg. The physical examination was remarkable for confusion and agitation. CT head did not reveal any intracranial abnormalities. Serum studies revealed sodium 114 mmol/L, potassium 3.6 mmol/L, creatinine 1.2 mg/dl, BUN 14 mg/dl, phosphorus 1.4 mmol/L and creatinine kinase (CK) 14,000 U/L, serum alcohol 3 mg/dl. Urinalysis was positive for blood, but no RBCs, consistent with rhabdomyolysis. This patient was admitted to the ICU for further management. He was treated with intravenous fluids and supportive care. The CK levels improved over the next 24-48 hours. Renal function also improved. The patient was ultimately discharged home in stable condition. Discussion In patients with alcoholism, functional immobilization due to acute alcohol intoxication causes rhabdomyolysis. Intracellular contents such as myoglobin can cause renal tubular necrosis, urinary obstruction and acute renal failure. In the setting of chronic alcoholism, muscle injury occurs due to electrolyte abnormalities. Severe hyponatremia is often concurrent with rhabdomyolysis in chronic alcohol abuse as was seen in our patient. The mainstay of treatment is plasma volume expansion and supportive care. As these patients do not have the typical history of immobilization, seizures, muscle pain, clinicians should be aware of this potentially life-threatening complication of chronic alcohol abuse. This abstract is funded by: None