Roy Sasmit, Konala Venu Madhav, Adapa Sreedhar, Naramala Srikanth, Bose Subhasish
Nephrology, University of Virginia, Lynchburg, USA.
Nephrology, Liberty University Medical School, Lynchburg, USA.
Cureus. 2020 Jun 13;12(6):e8595. doi: 10.7759/cureus.8595.
Cocaine toxicity is associated with several organ dysfunctions, including acute kidney injury (AKI). Rhabdomyolysis is the most likely mechanism that mediates AKI, and associated alcohol co-ingestion can amplify the situation. AKI, if severe, can result in end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). All patients with cocaine intoxication should be screened for rhabdomyolysis and AKI along with testing for other drug toxicity, including alcohol. Aggressive measures should be taken to treat the underlying cause that contributes to AKI, and the patients need to be educated about this severe condition. Our patient is a unique case where cocaine and alcohol co-ingestion led to severe rhabdomyolysis, AKI, and subsequently developed ESRD requiring ongoing hemodialysis (HD). He was on daily cocaine and alcohol co-ingestion for seven days and subsequently developed AKI with oliguria from rhabdomyolysis. His creatine kinase (CK) was significantly elevated to 141974 IU/L, and his serum creatinine was 11 mg/dl. Despite aggressive intravenous hydration, his kidney function did not improve, and he ended up needing HD for more than one year despite abstaining from cocaine.
可卡因中毒与多种器官功能障碍有关，包括急性肾损伤（AKI）。横纹肌溶解是介导急性肾损伤的最可能机制，同时摄入酒精会加剧这种情况。如果急性肾损伤严重，可能会导致终末期肾病（ESRD），需要进行肾脏替代治疗（RRT）。所有可卡因中毒患者都应筛查横纹肌溶解和急性肾损伤，同时检测其他药物毒性，包括酒精。应采取积极措施治疗导致急性肾损伤的潜在病因，并让患者了解这种严重情况。我们的患者是一个独特的病例，同时摄入可卡因和酒精导致严重的横纹肌溶解、急性肾损伤，随后发展为终末期肾病，需要持续进行血液透析（HD）。他连续七天每天同时摄入可卡因和酒精，随后因横纹肌溶解出现急性肾损伤并伴有少尿。他的肌酸激酶（CK）显著升高至141974 IU/L，血清肌酐为11 mg/dl。尽管进行了积极的静脉补液，他的肾功能仍未改善，尽管戒除了可卡因，但他最终仍需要进行一年多的血液透析。
