ABSTRACT
CME/Answers: Elevated Creatine Kinase as a Diagnostic Parameter of Rhabdomyolysis Abstract. Elevated CK values with or without symptoms require clarification in order to rule out possible secondary complications. Adequate hydrogenation, discontinuation of possibly triggering drugs and noxious agents, and close laboratory controls are decisive for the outcome. Acute rhabdomyolysis can have various causes, which can generally be classified as traumatic or atraumatic. In case of recurrent occurrence, genetic or autoimmunological diseases must also be excluded. In addition to a detailed anamnesis, physical examination, laboratory and urine tests, a variety of diagnostic methods are available, which should be used selectively. The aim of this work is to address possible clarification strategies, causes and differential diagnoses of an increase in creatine kinase and rhabdomyolysis. We illustrate these with a case.
Subject(s)
Acute Kidney Injury , Rhabdomyolysis , Acute Kidney Injury/diagnosis , Creatine Kinase , Diagnosis, Differential , Humans , Physical Examination , Rhabdomyolysis/diagnosis , Rhabdomyolysis/etiologyABSTRACT
CME: Elevated Creatine Kinase as a Diagnostic Parameter of Rhabdomyolysis Abstract. Elevated CK values with or without symptoms require clarification in order to rule out possible secondary complications. Adequate hydrogenation, discontinuation of possibly triggering drugs and noxious agents, and close laboratory controls are decisive for the outcome. Acute rhabdomyolysis can have various causes, which can generally be classified as traumatic or atraumatic. In case of recurrent occurrence, genetic or autoimmunological diseases must also be excluded. In addition to a detailed anamnesis, physical examination, laboratory and urine tests, a variety of diagnostic methods are available, which should be used selectively. The aim of this work is to address possible clarification strategies, causes and differential diagnoses of an increase in creatine kinase and rhabdomyolysis. We illustrate these with a case.
Subject(s)
Acute Kidney Injury , Rhabdomyolysis , Creatine Kinase , Humans , Rhabdomyolysis/diagnosis , Rhabdomyolysis/etiologyABSTRACT
AIMS: This short communication aims to review the treatment of cardiogenic shock in patients with yew poisoning based on two case reports from our institution, focusing on the use of extracorporeal life support (ECLS). METHODS AND RESULTS: We report two cases of Taxus baccata poisoning treated with ECLS at our institution and review the literature based on a search in PubMed and Google Scholar on the topic of yew poisoning and ECLS. All cases were combined for analysis of demographics, ECLS therapy, and outcome. Case 1: A 35-year-old woman developed polymorphic ventricular tachycardia followed by cardiovascular arrest 5 h after orally ingesting a handful of yew needles. Successful resuscitation required ECLS for 72 h due to ongoing cardiac arrhythmias and cardiogenic shock. The patient left the hospital without neurological sequelae after 10 days. Case 2: A 30-year-old woman developed refractory cardiac arrhythmias and circulatory arrest. Resuscitation included ECLS for 71 h. T. baccata needles found by gastroscopy confirmed the diagnosis. The patient had no neurologic deficits and was transferred to psychiatry after 11 days. REVIEW OF THE LITERATURE: Nine case reports were found and analysed along with our two cases. Five out of the 11 (45%) patients were female. Median (range) age was 28 (19-46) years. T. baccata needles were ingested with a suicidal intention in all patients. Median (range) duration of ECLS was 70 h (24-120 h). Eight (73%) patients had full neurological recovery. CONCLUSIONS: Yew poisoning is a differential diagnosis in young psychiatric patients presenting with polymorphic ventricular tachycardia and cardiogenic shock. A characteristic cardiac contraction pattern in echocardiography may present a diagnostic clue. The early use of ECLS is a valuable bridge to recovery in most of these patients.