A patient presented with a muscle condition depicted in photomicrograph.His urine colour is shown in the image.Which drugs can be implicated for a cause for this condition?
D. Any of the above.
Ans:D. Any of the above.
The patient is suffering from Rhabdomyolysis.
It is a condition in which damaged skeletal muscle breaks down rapidly.
Symptoms : Muscle pains, weakness, vomiting, confusion, tea-colored urine, irregular heartbeat
Complications: Kidney failure, high blood potassium, low blood calcium, disseminated intravascular coagulation, compartment syndrome.
Diagnostic method : Blood test (creatine kinase), urine test strip
Treatment :Intravenous fluids, dialysis, hemofiltration
Common and important causes
- Exercise related :Extreme physical exercise (particularly when poorly hydrated), delirium tremens (alcohol withdrawal), tetanus, prolonged seizures or status epilepticus
- Crush : Crush syndrome, blast injury, car accident, physical torture or abuse, or confinement in a fixed position such as after a stroke.
- Blood supply : Arterial thrombosis or embolism, clamping of an artery during surgery.
- Metabolism : Hyperglycemic hyperosmolar state, hyper- and hyponatremia (elevated or reduced blood sodium levels), hypokalemia (low potassium levels), hypocalcemia (low calcium levels), hypophosphatemia (low phosphate levels), ketoacidosis (e.g., in diabetic ketoacidosis) or hypothyroidism (abnormally low thyroid function)
- Body temperature : Hyperthermia , hypothermia
Drugs and toxins:
- Statins and fibrates.
- Antipsychotic medications may cause neuroleptic malignant syndrome, which can cause severe muscle rigidity with rhabdomyolysis and hyperpyrexia
- Neuromuscular blocking agents used in anesthesia may result in malignant hyperthermia, also associated with rhabdomyolysis
- Medications that cause serotonin syndrome, such as SSRIs
- Medications that interfere with potassium levels, such as diuretics
- Poisons linked to rhabdomyolysis are heavy metals and venom from insects or snakes.
- Hemlock may cause rhabdomyolysis, either directly or after consuming quail that have fed on it.
- Haff disease is rhabdomyolysis after consuming fish; a toxic cause is suspected but has not been proven.
- Drugs of abuse, including: alcohol, amphetamine, cocaine, heroin, ketamine, LSD and MDMA .
- Infection :Coxsackie virus, influenza A virus and influenza B virus, Epstein-Barr virus, primary HIV infection, Plasmodium falciparum (malaria), herpes viruses, Legionella pneumophila and salmonella
- Inflammation : Autoimmune muscle damage: polymyositis, dermatomyositis.