Rhabdomyolysis-Induced Acute Renal Injury in a Schizophrenic Patient

Abstract

Nowadays, schizophrenia is treated with atypical antipsychotics that can determine neuroleptic malignant syndrome or rhabdomyolysis appearance. In addition to trauma and muscular hypoxia, there are some drugs and toxins associated with rhabdomyolysis development, among which olanzapine. A case of severe rhabdomyolysis syndrome, with extremely high levels of serum creatine kinase (CK), followed by acute kidney failure, secondary to olanzapine overdose and prolonged immobilization is outlined. Continuous renal replacement therapy was performed, with a slow clearance of serum CK levels. Under supportive therapy, systemic alkalinisation with volume resuscitation and corticotherapy, patient’s general condition was improved, as well as his lower limb paresis. He followed frequent psychiatric evaluations and psychotherapies, before and after being transferred to a medical service. Rhabdomyolysis diagnosis is difficult in mild cases due to non-specific signs and symptoms, but it also has some typical manifestation, generically called “the rhabdomyolysis syndrome triad”. The treatment is usually supportive; renal replacement therapy is required in the presence of acute kidney injury unresponsive to aggressive volume resuscitation. The systemic myoglobin release is responsible for renal injury. Olanzapine muscle toxicity can lead to severe rhabdomyolysis syndrome complicated with acute kidney injury and multiple organ dysfunction syndrome. Rapid identification and aggressive therapeutic management are essential for improving patients’ outcome and prevent the occurrence of irreversible injuries.

Delayed-Onset olanzapine-induced rhabdomyolysis

“…Examples of delayed-onset olanzapine-induced rhabdomyolysis have been reported in the literature15 16 but are uncommon. Moreover, cases of olanzapine-induced rhabdomyolysis with creatine kinase peaks above 100 000 U/L are also uncommon even in cases of overdose 7 8 11. Comparing our case with the current literature, we emphasise the importance of recognising that olanzapine-induced rhabdomyolysis can occur with a delayed onset, in the absence of dose changes and overdose, and yet simultaneously be severe in nature.…”

“…The current report presented a case of olanzapine-induced rhabdomyolysis; our case was unique both due to its delayed onset, as well as the severity of rhabdomyolysis with a creatine kinase significantly higher compared with similar case reports 5–15. Of the case reports in the current literature, most involved either commencement of new therapy5 6 12 14 or an intentional overdose 7 8 11.…”

“…Though olanzapine-induced rhabdomyolysis is a rare adverse reaction occurring in fewer than 1 in 10 000 of those taking this medication, this report describes the very real possibility of this side effect and the serious sequelae that can occur, and demonstrates the highest creatine kinase level reported with this medication thus far 5–15…”

“…Less common and more serious complications include extrapyramidal movements, occurring in 0.1% of patients, and rhabdomyolysis, occurring in 0.1%–1.2% of patients 3 4. Previous reports of olanzapine-induced rhabdomyolysis typically describe this occurring soon after the initiation of treatment or in an overdose setting 5–15. Here we describe an unusual case of a person with olanzapine-induced rhabdomyolysis after decades of olanzapine use.…”