A young man with a pmh of anxiety who presented with lower extremity numbness and weakness after being down for several hours. Further workup revealed severe transaminitis as well as AKI and an elevated CK consistent with rhabdomyolysis. His UTox was positive for meth, which helped further explain his presentation.
-Hypovolemia, Metabolic Acidosis, Hyperthermia, and Rhabdomyolysis occur in a LARGE number of meth cases. Workup for suspected meth intoxication should include: serum electrolytes, lactate, CPK, ALT/AST, clotting times, and renal function – this patient had significant LFT derangements as well as rhabdo
-Rectal administration of meth is referred to as “booty bumping”
-Among patients with rhabdomyolysis, fluid repletion should be continued until plasma CK levels decrease to <5000 unit/L and urine is dipstick negative for hematuria
Kaiser SF Internal Medicine Residency Blog 