CASE REPORT   Open access

Italian Journal of Emergency Medicine 2022 April;11(1):45-8

DOI: 10.23736/S2532-1285.22.00114-8

Copyright © 2022 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.

language: English

Successful use of extracorporeal blood purification in treating severe cocaine-induced rhabdomyolysis

Modestina MADEO ¹, Stefania MAGNONI ¹, Domiziana PELLEGRINI ¹, Cristiana LAICI ² ✉, Elena MANCINI ³, Davide RICCI ³, Antonio SINISCALCHI ²

¹ Anesthesia and Intensive Care Residence, IRCCS University Hospital of Bologna, University of Bologna, Bologna, Italy; ² Unit of Postoperative Intensive Care and Abdominal Organ Transplant, Medical and Surgical Department of Digestive, Liver and Endocrine-Metabolic Diseases, IRCCS University Hospital of Bologna, Bologna, Italy; ³ Unit of Nephrology, Dialysis and Hypertension, Department of Nephro-Urologic Diseases, IRCCS University Hospital of Bologna, Bologna, Italy

According to our data, 1.3% of the adult population (15-64 yrs.) used cocaine at least once during 2019. Cocaine side effects are multiple since it interferes with the release and re-uptake of some neurotransmitters. Acute cocaine use is related with cardiovascular neurological, respiratory, and muscular side effects. This study describes the case of a 35-year-old man who was accepted into the ICU for acute cocaine intoxication. At first, he showed an altered mental status: then he developed a severe renal and liver failure associated with rhabdomyolysis. A few hours after his admission to the ICU, we decided to start a continuous veno-venous hemofiltration (CVVH) with Cytosorb (Aferetica, San Giovanni in Persiceto, Bologna, Italy), a filter that enhances the elimination of rhabdomyolysis products from the patient. Four days after admission, both liver and renal function significantly improved. Our patient developed exceptionally high values of creatine kinase, myoglobin, and markers of hepatic cytonecrosis if compared with other case reports in literature, and organ support therapies were fundamental to achieve a positive outcome for the patient. Our case report demonstrates that Cytosorb is a useful therapeutic strategy for severe cocaine intoxication associated with severe organ failure. There are no references in literature about the use of Cytosorb to treat severe cocaine intoxication. Cytosorb is a filter used during extracorporeal blood purification techniques designed to remove a wide range of molecules from the blood: pro- and anti-inflammatory cytokines, bilirubin, myoglobin, exotoxins, and drugs.

KEY WORDS: Cocaine; Rhabdomyolysis; Substance-related disorders