Rhabdomyolysis after Loss of Consciousness due to Alcoholic Intoxication

Abstract

We report a case of rhabdomyolysis complicated by acute renal failure caused by loss of consciousness after drinking. A 46-year-old man fell asleep in his living room after drinking beer and whisky. Showing no signs of awakening by 10 a.m. the next morning, he was transferred to our emergency center. On admission his consciousness level was II-30 (Japan coma scale), and his temperature was 31.1°C. Laboratory data showed hypoglycemia; mixed acidosis; and elevation of CPK, GOT and LDH. The serum ethanol concentration was 221mg/dl. At the midnight on the first hospital day, swelling of the right hip area develope and it declined to be growing. The patient's consciousness gradually returned, however, he remained oliguric despite treatment with fluid challenge and diuretics. A diagnosis of rhabdomyolysis complicated by acute renal failure was made, and hemodialysis was performed. A triacetate membrane was selected as the dialyzer in order to eliminate serum myoglobin. The acute renal failure improved after hemodialysis 20 times in 38 days. The cause of the rhabdomyolysis is believed to have been pressure necrosis due to immobility for many hours in addition to muscle damage caused by ethanol. Hemodialysis with a triacetate membrane was useful in eliminating myoglobin in acute renal failure caused by rhabdomyolysis.