Two chronic alcoholics developed acute renal failure from alcoholic myopathy (acute alcohol-induced rhabdomyolysis). Severe muscle pain developed and was associated with transitory oligo-anuric renal failure, requiring dialysis in one patient. In addition to the typical history and clinical symptoms, excessive elevation of muscle enzymes, especially creatine-kinase, and the appearance of myoglobin in serum are characteristic. Brown discoloration of the urine and a falsely positive test for "blood" due to the presence of myoglobin in urine in the absence of red blood cells are also typical. Definite changes can be demonstrated histologically and electromyographically during the acute stage. It is likely that this condition is more frequent than the sparsity of published reports indicates.
A 57-year-old patient suffering from late-onset McArdle9s disease developed myoglobinaemia, massive myoglobinuria and marked serum creatine kinase elevation subsequent to a routinely performed forearm ischaemic work test. Twenty hours after the test, enhancement of 99mTc methylene-diphosphonate activity was demonstrated exclusively in the tested forearm. It is concluded that the forearm ischaemic work test is potentially hazardous to McArdle patients, as it might induce myoglobinuria sufficient to result in acute myoglobinuric renal failure.
Abstract There are investment opportunities on 88 million acres of southern forestlands that offer financial rates of return competitively. Some of these investments will yield positive rates of return above inflation even if declining stumpage prices are projected. These investment opportunities include stocking control, stand conversion, and harvesting and regeneration of mature stands.
In 24 patients with biochemically proven rhabdomyolysis 34 scans with 99mTc-MDP were performed to detect regional as well as generalized myolysis. When performing the scan within 10 days after the maximum of myolysis, scintigraphic detection was possible in 95% of the patients, but after 20 days in none. Regional tracer accumulation in muscles was more frequent (89%) than generalized diffuse accumulation (31%). Predominantly muscles of the thigh, the buttocks and the upper arm were involved. Diffuse tracer accumulation in both kidneys occurred in 75% of patients with significant renal dysfunction. The results show that in addition to regional muscle damage generalized myolysis may be detected by scintigraphy with 99mTc-MDP. In cases of regional muscle damage scintigraphy proved to be more sensitive than clinical signs.
In 19 chronic alcoholics with rhabdomyolysis the clinical picture demonstrated markedly different degrees of severity of myolysis. Muscle pain, muscle swellings and brown-coloured urine were rare. But symptoms of delirium, at times with cerebral seizures, were frequent at the onset. Renal failure of different degrees was common; five patients had to be dialysed. Two patients died in irreversible shock. Respiratory insufficiency and hypercalcaemia were other complications. Early recognition of the disease is important, because early treatment can prevent acute "myoglobinuric" renal failure.
