Rhabdomyolysis in the Context of Designer Benzodiazepine Misuse
- PMID: 38234935
- PMCID: PMC10794082
- DOI: 10.7759/cureus.50741
Rhabdomyolysis in the Context of Designer Benzodiazepine Misuse
Abstract
Designer benzodiazepines belong to a class of lab-created psychoactive compounds, with limited federal regulation, no toxicity testing, and reported high potency, leading to substantial overdose risk and harmful clinical syndromes. Benzodiazepine misuse has been previously documented to be associated with rhabdomyolysis, with elevated creatine kinase (CK) during and after acute episodes of intoxication. Here, we present a case of profound rhabdomyolysis and associated acute kidney injury (AKI) after acute designer benzodiazepine intoxication. A 26-year-old male with a history of poly-substance misuse, including alcohol, psychedelics, opiates, kratom, and benzodiazepines, presented to the emergency department with altered mental status and agitation after an accidental overdose on liquid flubromazolam and clonazolam, designer benzodiazepines purchased online. He went on to develop seizure-like activity. Additional labs revealed AKI with creatinine 2.22 mg/dL (reference 0.74-1.35 mg/dL, baseline 0.88 mg/dL). He was discovered to have severe rhabdomyolysis that peaked at 131,920 U/L (reference 55-170 U/L) on the fourth day of admission. This case demonstrates the potential deleterious effects of the designer benzodiazepine class, including prolonged sedation, AKI, and severe rhabdomyolysis. In addition, seizure-like manifestations may occur during the intoxication or withdrawal phase. Designer benzodiazepines may produce rhabdomyolysis; however, the mechanism is unknown. Direct myotoxicity or prolonged immobilization may be contributors to rhabdomyolysis. More research is needed to elucidate the consequences of designer benzodiazepine misuse. Clinicians should be aware of their use given the ease of availability online and rising popularity.
Keywords: acute kidney injury; designer benzodiazepines; designer drugs; drug overdose; elevated creatine kinase; rhabdomyolysis; substance misuse.
Copyright © 2023, Noe et al.
Conflict of interest statement
The authors have declared that no competing interests exist.
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References
-
- Flubromazolam--a new life-threatening designer benzodiazepine. Łukasik-Głębocka M, Sommerfeld K, Teżyk A, Zielińska-Psuja B, Panieński P, Żaba C. Clin Toxicol (Phila) 2016;54:66–68. - PubMed
-
- Clinical toxicology of newer recreational drugs. Hill SL, Thomas SH. Clin Toxicol (Phila) 2011;49:705–719. - PubMed
-
- Overdose from designer benzodiazepine diclazepam. Runnstrom M, Kalra SS, Lascano J, Patel DC. QJM. 2020;113:122–124. - PubMed
-
- Rhabdomyolysis and acute renal failure following an overdose of doxepine and nitrazepam. Højgaard AD, Andersen PT, Møller-Petersen J. Acta Med Scand. 1988;223:79–82. - PubMed
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