Rhabdomyolysis and Acute Renal Failure After Fire Ant Bites

Koya, Supriya; Crenshaw, Daryl; Agarwal, Anupam

doi:10.1007/s11606-006-0025-z

Cited by 31 publications

(20 citation statements)

References 15 publications

(11 reference statements)

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“…This finding is consistent with reported DPH-induced inhibition of I Kr in guinea pig ventricular myocytes and QTc prolongation in healthy volunteers given oral DPH [15]. The IC 50 for blockade of the delayed rectifier potassium current is 30 μM, approximately 40 times therapeutic diphenhydramine concentrations [15]. Again, the DPH concentrations necessary to produce this blockade are unlikely to be achieved with therapeutic dosing, but may be within the range of plasma concentrations achieved in the setting of overdose.…”

Section: What Is the Pharmacology Of Dph?supporting

confidence: 92%

“…A number of snake venoms are associated with rhabdomyolysis, including pit vipers (Subfamily Crotalinae), true vipers (Subfamily Viperinae), sea snakes (Family Hydrophiidae), and Australasian elapids (Family Elapidae) [49]. Rhabdomyolysis has been reported following envenomation by insects of the Order Hymenoptera, including hornets, wasps, honey bees, and fire ants with clinically significant rhabdomyolysis being reported only following multiple stings [50][51][52][53][54]. Rhabdomyolysis has been rarely reported with spider envenomation including that of the genera Latrodectus and Loxosceles [55][56][57].…”

Section: What Other Xenobiotics Cause Rhabdomyolysis?mentioning

confidence: 99%

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Case Files of the Medical Toxicology Fellowship at Drexel University

Vearrier

Curtis

2011

J. Med. Toxicol.

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A 28-year-old female was brought to the emergency department (ED) by her roommate after a suicide attempt, in which the patient took 29 capsules of an over-the-counter (OTC) sleep aid containing 50 mg of diphenhydramine (DPH) per capsule, for a total of 1450 mg, and consumed 100 ml of vodka. Her weight was 67 kg, yielding a dose of 22 mg/kg DPH. When a roommate arrived home from work several hours later, he noticed that the patient was walking aimlessly through the house and that "she was out of it." The patient subsequently informed the roommate of her suicide attempt, at which point he brought her by car to our ED. According to the patient, the ingestion occurred 9 h prior to arrival.In the ED, the patient complained of bilateral tingling and numbness in her legs and feet that had started within the last 4 h. She had a subjective sensation of inability to control the muscles in her legs and leg weakness. The patient denied any history of leg trauma, recent strenuous physical activity, or recent prolonged inactivity. Her medical history was significant for cervical dysplasia status post surgical excision and major depressive disorder. The patient denied taking any other prescribed or OTC medications, which her roommate corroborated.Physical examination revealed a young, disheveled female with normal body habitus. Initial vital signs included a temperature of 36.4°C, heart rate 123 beats/ min, respiratory rate 18 breaths/min, blood pressure 112/ 83 mm Hg, and pulse oximetry of 98% on room air. Pupils were 6 mm bilaterally and sluggishly reactive to light. Extraocular movements were intact. The mucous membranes of the oropharynx were dry. Cardiac examination was significant for a regular tachycardia, while the pulmonary examination was normal. Abdominal examination was significant for bowel sounds being present but decreased. The patient was alert and oriented to self and place, but not to time. She was able to answer simple questions, but was slow to respond. Strength, sensation, and deep tendon reflexes were normal. No ataxia or tremor was present. Extremity examination was significant for mottled skin color on the anterior legs bilaterally. Dorsalis pedis and posterior tibialis pulses were normal, as was sensation, strength, and capillary refill throughout the bilateral lower extremities. What is the Pharmacology of DPH?DPH is a first-generation H 1 antihistamine. It belongs to the ethanolamine subclass of antihistamines along with carbinoxamine, clemastine, dimenhydrinate, and doxylamine. Histamine receptors are categorized into four subtypes This case report was presented in poster form at the EAPCCT conference in 2009 in Stockholm, Sweden.

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Section: What Is the Pharmacology Of Dph?supporting

confidence: 92%

Section: What Other Xenobiotics Cause Rhabdomyolysis?mentioning

confidence: 99%

Case Files of the Medical Toxicology Fellowship at Drexel University

Vearrier

Curtis

2011

J. Med. Toxicol.

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“…Idealmente debe medirse por radioinmunoensayo, pero el resultado tarda más de 24 horas lo que limita su uso en la práctica clínica. La mioglobina parece tener un papel en determinar el pronóstico de la lesión renal asociada a rabdomiolisis, pero este beneficio no está muy bien establecido (42,43,45,(47)(48)(49).…”

Section: Mioglobinaunclassified

“…En los estadios iniciales la relación BUN/creatinina se encuentra baja por aumento de la creatinina en sangre secundaria al catabolismo muscular; en los estadios tardíos la mioglobina se metaboliza a urea por lo cual la relación BUN/creatinina aumenta en forma desproporcionada con respecto a las lesiones renales por otras causas (15,16,18,23,25,(30)(31)(32)(33)42,43,45,(47)(48)(49).…”

Section: Productos Nitrogenadosunclassified

Insuficiencia renal aguda inducida por rabdomiolisis

Nieto-Ríos

Vega-Miranda

Higuita

2016

iatreia

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RESUMENLa insuficiencia renal aguda (IRA) es una causa frecuente de morbilidad y mortalidad en los servicios de urgencias, hospitalización y cuidado crítico, siendo la rabdomiolisis responsable del 15 % de los casos en los centros hospitalarios de alta complejidad. La rabdomiolisis consiste en daño muscular con necrosis y liberación a la circulación de componentes intracelulares, y puede tener múltiples causas. El daño renal por rabdomiolisis es multifactorial e incluye obstrucción tubular, vasoconstricción y daño oxidativo. El tratamiento principal de la IRA por rabdomiolisis es la hidratación, forzar la diuresis y evitar los fármacos nefrotóxicos. Cuando el daño es lo suficientemente grave para causar uremia, acidosis metabólica, hiperpotasemia y sobrecarga de volumen se debe recurrir a la terapia de reemplazo renal. Aunque la regla es que se recupere la función renal, estos pacientes tienen mayor riesgo futuro de desarrollar enfermedad renal crónica. PALABRAS CLAVEInsuficiencia Renal Aguda; Mioglobina; Músculo Esquelético; Necrosis; Rabdomiolisis SUMMARY Acute renal failure due to rhabdomyolyisisAcute renal failure is a frequent cause of morbidity and mortality in emergency, hospitalization and critical care services. In 15 % of cases it is due to rhabdomyolysis, in which there is breakdown of skeletal muscle with massive necrosis and leakage of muscle cell contents into the circulation. It has many different etiologies. The rhabdomyolysis-induced acute kidney injury results from the combination of several mechanisms, including tubular obstruction, vasoconstriction and oxidative stress. The most important therapeutic measures are: Aggressive repletion of fluids, forced diuresis and avoidance of exposure to nephrotoxic substances. In cases of

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“…Most studies that describe the clinical aspects of ant stings reported accidents with ants of the genus Solenopsis (Myrmicinae), known as fire ants [20,21,22]. In most serious cases, these accidental encounter with fire ants can promote multiple body rash, seizures, heart failure, and serum sickness nephritis and, more rarely, acute renal failure [23,24].…”

Section: Clinical Aspects Of Ants' Stingsmentioning

confidence: 99%