Unusual consequences of heroin overdose: rhabdomyolysis, acute renal failure, paraplegia and hypercalcaemia

• Published in: British Journal of Anaesthesia Vol. 83; no. 3; pp. 496 - 498
• Main Authors: Kumar, R, West, D M, Jingree, M, Laurence, A S
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford Elsevier Ltd 01.09.1999; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Acute Kidney Injury - chemically induced; Aged; Biological and medical sciences; Drug addictions; Drug Overdose; Heroin Dependence - complications; Humans; Hypercalcemia - chemically induced; Male; Medical sciences; Paraplegia - chemically induced; Rhabdomyolysis - chemically induced; Toxicology; Kidney disease; Human; Nervous system diseases; Hydroelectrolytic balance disorder; Urinary system disease; Motor system disorder; Acute; Rhabdomyolysis; Inorganic element; Case study; Hypercalcemia; Striated muscle disease; Metabolic disorder; Paraplegia; Renal failure; Complication; Overdose; Neurological disorder; Heroin
• DOI: 10.1093/bja/83.3.496
• ISSN: 0007-0912

A 29-yr-old man, known to be a heroin addict, was found at home totally unrousable, bent on his hips in the lotus position. On admission, he required frequent ventricular defibrillation, external pacing and infusion of calcium. A diagnosis of rhabdomyolysis caused by heroin and cocaine overdose was made. He developed paraplegia below T12, acute renal failure, acute compartment syndrome in one leg and a coagulation defect. Despite a fasciotomy, a through-knee amputation of the leg was required. Haemodialysis was required for 26 days, and this period was complicated by increased serum calcium concentrations, which was treated with disodium pamindrate. Calcium deposits were palpable in the muscles and could be seen in vessels on limb x-rays. After 34 days, he was eventually discharged to a general surgical ward and subsequently into the community.