1376: PLASMAPHERESIS FOR TREATMENT OF MDMA-INDUCED RHABDOMYOLYSIS

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Abstract

Learning Objectives: Methylenedioxymethamphetamine (MDMA, aka ecstasy) and other stimulant street drugs have known overdose complications including hyperthermia, acute kidney injury, and rhabdomyolysis. The management of rhabdomyolysis has traditionally been supportive with aggressive intravenous fluid hydration. Here we report the use of therapeutic plasmapheresis in the management of a healthy adult male presenting with severe rhabdomyolysis and multi-organ dysfunction following MDMA overdose. Methods: A 24-year-old male with no known past medical history was brought to the hospital after being found down at a rave with a GCS of 3, hyperthermia with temperature of 109 F, and urine drug screen test positive for MDMA, phencyclidine, and amphetamine. Presenting creatine kinase (CK) level was 23,000 U/L, presumed secondary to heme pigment-induced AKI. Patient was oliguric with increasing CK levels despite aggressive IV fluid hydration. He was started on hemodialysis (HD) on hospital day 2. Given patient's severe degree of rhabdomyolysis and worsening renal function despite daily HD, therapeutic plasmapheresis to remove CK from circulating plasma was initiated. Patient underwent 4 sessions of plasmapheresis with serum CK level decreasing from 630,000 U/L to 23,000 U/L. Patient showed complete recovery of renal function prior to discharge. Results: Therapeutic plasmapheresis involves the removal, treatment, and return of patient plasma to remove pathogenic substance from the blood. The removed plasma is typically replaced with albumin in saline or fresh frozen plasma (FFP). In theory, extracorporeal techniques such as plasmapheresis have low effectiveness in treatment of rhabdomyolysis due to the molecular nature of myoglobin, which is non-spherical, carries a low diffusion coefficient, and possesses a steric effect that can be rejected by membrane pores. In our patient, we employed therapeutic plasmapheresis with FFP in an attempt to remove excess CK by replacing all plasma constituents, and thereby preventing worsening rhabdomyolysis. We found that our treatment not only significantly decreased CK levels, but also led to eventual recovery of renal function. This is the first published case, to the best of our knowledge, to use plasmapheresis for the treatment of rhabdomyolysis secondary to MDMA ingestion.
Original languageAmerican English
Pages (from-to)671-671
Number of pages1
JournalCritical Care Medicine
Volume46
Issue number1
DOIs
StatePublished - Jan 1 2018

Disciplines

  • Anesthesiology
  • Medicine and Health Sciences
  • Critical Care

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