Rhabdomyolysis after Intentional Acetaminophen and Carbon Monoxide Poisoning

Iago Rodríguez–Lago, Delia D’Avola, Mercedes Iñarrairaegui, José Ignacio Herrero, Bruno Sangro, Jorge Quiroga


Acetaminophen is one of the most frequent causes of acute liver failure. Rhabdomyolysis is a rare adverse reaction reported with this drug. Carbon monoxide (CO) can also lead to muscle injury but only after severe intoxication. We present a case of rhabdomyolysis associated to Acetaminophen over dosage and mild carbon monoxide exposure. A 38-year-old man was admitted because of acute hepatic injury due to voluntary acetaminophen overdose. He also reported a mild carbon monoxide exposure. He showed a delayed rising of serum creatinine with minimal elevation of other markers of renal damage. Although he was asymptomatic, rhabdomyolysis was suspected and confirmed by blood and urine analysis. The patient recovered spontaneously with conservative management. This is the first report of rhabdomyolysis associated with acetaminophen overdose in which mild CO exposure could play a contributive role.

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