Hyperthermia and rhabdomyolysis in self-poisoning with paracetamol and salicylates. Report of a case.

A young women ingested large amounts of different analgesics, mainly salicylate and paracetamol. On admission about 17 hours later, clearly toxic serum levels of both drugs were demonstrated. She was comatose with respiratory failure for 5 days. During the first day there was a period of several hours of therapy-resistant hyperthermia. A severe bleeding tendency was probably related to profound coagulation defects. Persistingly elevated serum levels of ASAT and ALAT for two weeks were presumably caused by a toxic effect of paracetamol on the liver. When consciousness was regained, widespread pareses of skeletal muscles, predominantly of the lower limbs, were demonstrated. These were related to extensive rhabdomyolysis as evidenced by extremely elevated serums levels of CPK for 6 weeks, and by muscle necrosis in biopsy specimens. There was a gradual improvement, but walking disturbances were still present after one year. The hyperthermia was probably related to the cerebral effects of salicylates or the combination of multiple drugs. The rhabdomyolysis might be related to a deleterious effect of hyperthermia on the muscles or to an effect of paracetamol on the skeletal muscles similar to that which might occur in the myocardium, or to a combination of these mechanisms.