Abstract | March 24, 2024

A Rare Methamphetamine Triad: Compartment Syndrome, Rhabdomyolysis, and Severe Renal Failure

Matthew Fry, DO, Family Medicine, PGY3, Kettering Health Dayton, Dayton, OH

Emana Sheikh-Kapadia, DO, Family Medicine, PGY1, Kettering Health Dayton, Dayton, OH

Learning Objectives

  1. Discuss the rare, yet high mortality effects of methamphetamine (MA) toxicity, especially in absence of the more common MA-use symptoms like hyperthermia, psychomotor agitation, and hallucinations
  2. Identify the steps in management of a severe MA-induced case of compartment syndrome, rhabdomyolysis, and kidney failur
  3. Recognize that delayed management of reversible MA-induced conditions can result in potentially permanent, even fatal complications

Introduction: Methamphetamine (MA) abuse resulting in rhabdomyolysis and acute kidney injury (AKI) are well-documented patient stories, typically following a more mild course to recovery, from same day discharge to short hospital stays, and minimal renal sequelae. Only two published reports present MA-induced compartment syndrome, resulting in severe rhabdomyolysis, fulminant kidney failure, and need for hemodialysis.

Case Presentation: A 48-year-old male with known polysubstance abuse including intravenous drug-use presents to the emergency department (ED) with complaint of severe right lower and left upper extremity pain after recent intramuscular (IM) MA use. While in ED, diagnosis of compartment syndrome of right leg and left forearm prompts emergent fasciotomy of both extremities and subsequent admission. Rising creatine phosphokinase (CK) levels to >100,000, believed to be rhabdomyolysis-induced and secondary to muscle ischemia from compartment syndrome, necessitates right below-knee amputation. During patient stay, kidney function shows little improvement, spurring nephrology decision for aggressive renal stabilization by hemodialysis, resulting in improvements to creatinine, electrolyte, and CK levels. As the patient reached goal medical milestones, he is discharged to a long-term care facility for continued optimization.

Final Diagnosis: We present a patient whose initial presentation of upper and lower extremity pain after recent IM MA use was found to have two, simultaneous compartment syndrome sites prompting fasciotomy and lower extremity below-knee amputation. The patient’s rhabdomyolysis was complicated by fulminant kidney failure.

Management and Outcome: Though the patient reached successful inpatient medical stabilization, he received thorough education on the road to recovery ahead, complicated by his chronic conditions including diabetes mellitus and chronic obstructive pulmonary disease. Soon after discharge, non-healing wounds and soft tissue infection in his right leg stump necessitated re-admission for right leg stump revision and irrigation. A five-year study following MA and rhabdomyolysis accounts a growing number of cases presenting with MA toxicity annually. Thus, practitioners must carry high suspicion for the rare yet severe MA toxicity side effects to better facilitate reduced risk of long-term complications in high mortality patients.2 Our patient’s story, similar to the very few previously reported, opens a significant area of future study.

References and Resources

  1. Hajnoczky N, George D. A Rare Case of Methamphetamine-Induced Severe Rhabdomyolysis and Compartment Syndrome. Cureus. 2023 May 31;15(5):e39804. doi: 10.7759/cureus.39804. PMID: 37398711; PMCID: PMC10313496.
  2. Richards JR, Johnson EB, Stark RW, Derlet RW. Methamphetamine abuse and rhabdomyolysis in the ED: a 5-year study. Am J Emerg Med. 1999 Nov;17(7):681-5. doi: 10.1016/s0735-6757(99)90159-6. PMID: 10597089.
  3. NIDA. 2023, February 13. What is the scope of methamphetamine use in the United States?. Retrieved from https://nida.nih.gov/publications/research-reports/methamphetamine/what-scope-methamphetamine-misuse-in-united-states on 2023, November 14.