Crush syndrome, of which little is known, occurs as a result of compression injury to the muscles. This syndrome is characterized by systemic manifestations such as acute kidney injury (AKI), hypovolemic shock, and hydroelectrolytic variations. This pathology presents high morbidity and mortality if not managed aggressively by prehospital care.

A 40-year-old worker was rescued after being buried underground in a ditch for 19 hours. The patient was administered early resuscitation with isotonic solutions and monitored during the entire rescue operation. Despite having increased plasma levels of total creatine kinase (CK), the patient did not develop AKI or hydroelectrolytic variations.

Aggressive early management with isotonic solutions before hospital arrival is an effective option for nephron-protection and prevention of crush syndrome.

MardonesA , ArellanoP , RojasC , GutierrezR , OliverN , BorgnaV . Prevention of Crush Syndrome through Aggressive Early Resuscitation: Clinical Case in a Buried Worker. Prehosp Disaster Med. 2016;31(3):340–342.

To review consequences of the changing demographic profile of anabolic-androgenic steroid (AAS) use.

Case report and review of key papers.

We report here a case of a 19-year-old Irish male presenting with both medical and psychiatric side effects of methandrostenolone use. The man had a long-standing history of harmful cannabis use, but had not experienced previous psychotic symptoms. Following use of methandrostenolone, he developed rhabdomyolysis and a psychotic episode with homicidal ideation.

Non-medical AAS use is a growing problem associated with medical, psychiatric and forensic risks. The population using these drugs has changed with the result of more frequent poly-substance misuse, potentially exacerbating these risks.

A higher index of suspicion is needed for AAS use. Medical personnel need to be aware of the potential side effects of their use, including the risk of violence. Research is needed to establish the magnitude of the problem in Ireland.

Rhabdomyolysis is a potentially life-threatening syndrome that can develop from various causes. This study was undertaken to analyse the clinical spectrum and to evaluate the prevalence of various aetiologies in psychiatric patients with rhabdomyolysis.

We retrospectively analysed the medical charts of 87 patients. For them, serum creatine kinase (SCK) activity higher than 1500 IU/l was defined as rhabdomyolysis. The causes of increased SCK activity were assessed.

The annual incidence of rhabdomyolysis during 2007–2012 was 0.8–1.45%. In 59 men and 28 women (17–87 years old; median 50.9 years), no relation was found between age and the highest value of SCK activity. Their SCK activities were 1544–186 500 IU/l (median 3566 IU/l), but 45% had SCK activity higher than 5000 IU/l. Men were at greater risk than women. Major aetiologic factors were medical drugs, excessive physical activity, and psychogenic polydipsia. Patients with psychogenic polydipsia and alcoholism had higher SCK activity. Acute kidney injury (AKI) occurred in 8 men (9.1%). Five patients died, but only one died of rhabdomyolysis.

Most psychiatric patients with rhabdomyolysis were asymptomatic. The increase in SCK activity subsided spontaneously without specific treatment.

Serum creatine kinase and myoglobin elevation has been described involving muscle manipulation after surgery and also after bariatric, urologic and gynaecologic procedures. It encompasses a wide range of severity, reflecting in the worst cases true rhabdomyolysis. We occasionally noted creatine kinase elevations after intracranial neurosurgery, an occurrence that has not yet been described. To assess whether the issue of postoperative muscle enzyme elevation is relevant to neurosurgery, we prospectively measured serum creatine kinase and myoglobin in a series of neurosurgical patients submitted to craniotomy.

We studied 30 patients aged 22–69 yr submitted to craniotomy. Blood samples were taken prior to the procedure, at the end of anaesthesia and on the first, second and third postoperative days. Blood was checked for creatine kinase, myoglobin, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine and serum electrolytes. We recorded the patient’s age, sex, height, weight and body mass index. Throughout surgery, we recorded the highest and the lowest body temperature and sampled the mean arterial pressure at 5 min intervals. We performed backwards stepwise logistic regression analysis to identify the elements that best correlate with the development of cell muscle damage.

On the first postoperative day creatine kinase peaked from baseline (305 (107–1306) UI L−1 vs. 59 (42–94) UI L−1; P < 0.001) while myoglobin rose significantly from baseline to the end of surgery (70 (42–147) ng mL−1 vs. 36 (30–44) ng mL−1; P = 0.002). Logistic regression showed that length of surgery was the only factor clearly influencing peak creatine kinase (P < 0.001; R2 0.7) and myoglobin (P = 0.011; R2 0.41) concentration.

Creatine kinase and myoglobin elevation may occur after intracranial neurosurgery. In our series, length of surgery was a risk factor.