Roth D, Alarcón F J, Fernandez J A, Preston R A, Bourgoignie J J
Department of Medicine, University of Miami School of Medicine, Fla. 33101.
N Engl J Med. 1988 Sep 15;319(11):673-7. doi: 10.1056/NEJM198809153191103.
Because an increasing number of patients were arriving at our emergency room with cocaine intoxication and rhabdomyolysis, we reviewed our experience with such patients. We identified 39 patients seen at our institution over an eight-year period with acute rhabdomyolysis after cocaine use. The patients' mean creatine kinase level was 12,187 U per liter (range, 1756 to 85,000). Thirteen of the 39 patients (33 percent) had acute renal failure; 6 of them died. In comparison to the patients with normal renal function, those with renal failure were more often admitted with profound hypotension (46 vs. 4 percent; P less than 0.001), hyperpyrexia (69 vs. 15 percent; P less than 0.001), and markedly elevated serum creatine kinase levels (mean, 28,084 vs. 7931 U per liter; P less than 0.01). Disseminated intravascular coagulation developed in seven patients with renal failure. All six deaths were in this group. Severe hepatic dysfunction was found in 11 patients with renal failure. We conclude that cocaine intoxication can cause acute rhabdomyolysis with acute renal failure, severe liver dysfunction, and disseminated intravascular coagulation and that the mortality rate among patients with this syndrome is high.
由于越来越多可卡因中毒并伴有横纹肌溶解的患者前来我们的急诊室就诊，我们回顾了对此类患者的治疗经验。我们确定了在八年期间在我们机构就诊的39例使用可卡因后发生急性横纹肌溶解的患者。这些患者的平均肌酸激酶水平为每升12,187 U（范围为1756至85,000）。39例患者中有13例（33%）发生急性肾衰竭；其中6例死亡。与肾功能正常的患者相比，肾衰竭患者更常因严重低血压（46%对4%；P<0.001）、高热（69%对15%；P<0.001）和血清肌酸激酶水平显著升高（平均每升28,084对7931 U；P<0.01）而入院。7例肾衰竭患者发生了弥散性血管内凝血。所有6例死亡患者均在该组。11例肾衰竭患者存在严重肝功能障碍。我们得出结论，可卡因中毒可导致急性横纹肌溶解并伴有急性肾衰竭、严重肝功能障碍和弥散性血管内凝血，并且该综合征患者的死亡率很高。
