Rhabdomyolysis and Aminotransferase Activity Due to Acute Intoxication With Psychotropic and Chemical Substances

Abstract

Background: Rhabdomyolysis is caused by the release of enzymes from skeletal muscles into the blood, which leads to systemic complications with diverse etiologies. This study evaluated the serum aminotransferases in patients with rhabdomyolysis following acute intoxication with either psychotropic drugs or other chemical agents. Methods: This study randomly recruited 140 patients suffering from rhabdomyolysis. They were divided into two groups affected by either psychotropic drugs or chemical agents. Rhabdomyolysis was defined as having serum creatine kinase (CK) levels greater than 250 U/L, based on the poisoning severity score. Results: On day 1, the CK/AST correlation was significantly stronger in the psychotropic than the chemical group (P=0.0009). On day 5, patients in the psychotropic group had significantly higher AST (P=0.0138) and ALT (P=0.0129) than those poisoned with other chemicals. The difference in the strength of the CK/ALT correlation between the two groups was insignificant. Between the two groups, the differences between the CK levels and the following serum parameters were insignificant: Alkaline phosphatase; gamma-glutamyl transferase; prothrombin time; total bilirubin; and albumin. Conclusion: The elevated aminotransferases in patients with rhabdomyolysis due to acute psychotropic toxicity might have resulted from the skeletal muscle injury rather than hepatotoxicity. In rhabdomyolysis patients poisoned with other chemicals, the elevated serum aminotransferases are likely due to liver toxicity arising from the consumed substances. These patients are likely to manifest clinically severe long-term multi-organ failure. Intoxications with typical agents, such as herbicides, petroleum distillates, and corrosives were responsible for the rhabdomyolysis in the second group.