Clinical evaluation of rhabdomyolysis/malignant syndrome-related acute renal failure (ARF) caused by neuroleptic prescriptions

Abstract

Rhabdomyolysis, which is caused by various factors, may induce acute renal failure or even death, if not treated properly.
We encountered four cases of rhabdomyolysis with ARF from September 2001 to March 2004. All patients had been prescribed neuroleptics for long periods. Case 1 developed malignant syndrome. Forced diuresis and hemodialysis (HD) were performed simultaneously. The patient recovered and was discharged 45 days later. Case 2 was suspected of having malignant syndrome. Forced diuresis and HD were performed similarly, but the body temperature rose to over 40°C and the patient died on the fifth day after onset. Case 3 was caused by trauma. The patient was treated by forced diuresis and hemodiafiltration (HDF), and discharged after 45 days. Case 4 was caused by infection and dehydration. Only forced diuresis was applied to the patient, and he was discharged on the 81st day of hospitalization.
Based on our experiences with these 4 cases of rhabdomyolysis-induced ARF, forced diuresis should be applied immediately. For those of oliguria, blood purification therapy should be added simultaneously. Some reports recommend, as a blood purification therapy, HDF or plasma adsorption should be applied instead of HD for the purpose of myoglobin elimination. However, there is no solid evidence.