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The cohort comprised patients with CK activity above 50,000 U/l selected from 7708 cases treated at a regional toxicology center. Recreational drugs, sedatives, and anti-epileptics were the most frequent causative agents. Multi-organ failure occurred in six patients, including one death; substance abuse disorder was diagnosed in 90%. Acute kidney injury was observed in 90%, and 70% required renal replacement therapy, with longer hospitalization. Creatinine concentration differences between days 2 and 1 correlated with stay length (r=0.73, p=0.02), and negative differences predicted no dialysis need. Findings suggest multiple coincident factors drive outcomes rather than myotoxicity alone.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/the-characteristics-and-outcomes-of-toxin-induced-massive-rhabdomyolysis/466001/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/the-characteristics-and-outcomes-of-toxin-induced-massive-rhabdomyolysis/466001.png","ImageObject",300,407,{"name":92,"@type":93},"dabgoudw","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the study’s main objective?","Question",{"text":112,"@type":113},"To investigate common patterns in patients with exceptionally high creatine kinase (CK) levels and identify factors contributing to severe massive rhabdomyolysis in the cohort.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which substances were most frequently associated with massive rhabdomyolysis in the results?",{"text":117,"@type":113},"Recreational drugs, sedatives, and anti-epileptics were the most frequent causative agents.",{"name":119,"@type":110,"acceptedAnswer":120},"How did kidney injury and dialysis needs relate to creatinine differences during hospitalization?",{"text":121,"@type":113},"Acute kidney injury occurred in 90%, and 70% required renal replacement therapy. Creatinine concentration differences between days 2 and 1 correlated with hospital stay length, and patients with negative differences did not need dialysis.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},466001,1791095135,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},3985747860484,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","O R I G I N A L P A P E R  \nInternational Journal of Occupational Medicine and Environmental Health 2020;33(5):661–673 [https://doi.org/10.13075/ijomeh.1896.01532](https://doi.org/10.13075/ijomeh.1896.01532)  \nTHE CHARACTERISTICS AND OUTCOMES  \nOF TOXIN-INDUCED MASSIVE RHABDOMYOLYSIS  \nWOJCIECH WALDMAN1,2, JACEK SEIN ANAND1,2, and PIOTR KABATA2  \n1 Medical University of Gdańsk, Gdańsk, Poland  \nFaculty of Health Division, Department of Clinical Toxicology  \n2 Pomeranian Center of Toxicology, Gdańsk, Poland  \nAbstract  \nObjectives: This study investigates common patterns in patients with exceptionally high creatine kinase (CK) levels to identify factors that could have contributed to the development of severe rhabdomyolysis in the studied cohort. Material and Methods: The authors present a retrospective analysis of patients with massive rhabdomyolysis (measured CK activity >50 000 U/l) caused by xenobiotics. The patients were selected from a group of 7708 patients treated at the Regional Toxicological Center. Results: The most frequent causative agents were recreational drugs, sedatives and anti-epileptics. Six patients developed multi-organ failure, including 1 who died. Substance abuse disorder was diagnosed in 90% of the patients. Each patient had at least 1 contributory factor present (hypothermia, hyperthermia, injury, an episode of agitation, seizures, prolonged immobilization), and the median was 3 factors. Acute kidney injury was observed in 90% of the patients, and 70% needed renal replacement therapy due to acute renal failure, which meant a longer hospital stay. Creatinine concentration differences between days 2 and 1 of the presentation (Cdiff) correlated with the length of hospital stay (r = 0.73, p = 0.02). All patients with negative Cdiff values did not need dialysis. No patients experienced liver failure. Conclusions: Massive rhabdomyolysis seems to be the effect of coincidence of several factors rather than the myotoxic effect alone. A creatinine concentration difference between days 2 and 1 of hospitalization was a good prognostic factor for the need for further dialysis. Int J Occup Med Environ Health. 2020;33(5):661–73  \nKey words:  \ndrugs, acute kidney injury, rhabdomyolysis, acute poisoning, musculoskeletal injury, novel psychoactive substance  \nINTRODUCTION  \nPolypharmacy and an ongoing rise in the popularity of novel psychoactive substance (NPS) use brings a plethora of new toxins that can induce rhabdomyolysis, sometimes very severe, in patients. An adequate and quick treatment of this condition causes quick reversal of organ injuries leading to a shorter hospital stay and reduced healthcare costs.  \nRhabdomyolysis is a syndrome caused by myocyte damage. It consists of clinical and biochemical features that are the result of the release of muscle cell contents. Some of  \nthose substances are available on most laboratories’ standard test panels, i.e., myoglobin concentration, creatine kinase (CK) activity, and the levels of electrolytes, lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) . Other compounds (phospholipaseA, Ca2+-dependent phosphorylases, nucleases, proteases, and free radicals) may require advanced analytical methods while not adding any substantial clinical value. Importantly, these substances are relevant in the development of complications of rhabdomyolysis. Muscle cells are affected either by direct cell membrane  \nReceived: August 26, 2019. Accepted: May 22, 2020.  \nCorresponding author: Wojciech Waldman, Medical University of Gdańsk, Faculty of Health Division, Department of Clinical Toxicology, Kartuska 4/6, 80-104 Gdańsk, Poland ([e-mail: waldman.wojciech@gmail.com](e-mail: waldman.wojciech@gmail.com)).  \nNofer Institute of Occupational Medicine, Łódź, Poland 661  \ndestruction or by energy depletion. Free ionized calcium enters the intracellular space and activates proteases and apoptosis pathways. The genesis and pathophysiology of r","cbCaiqVOQzrrC1Xz","https://ap.wps.com/l/cbCaiqVOQzrrC1Xz","pdf",204117,13,"English","# Abstract\n## Objectives\n## Material and Methods\n## Results\n## Conclusions\n# Introduction\n# Material and Methods","[{\"question\":\"What was the study’s main objective?\",\"answer\":\"To investigate common patterns in patients with exceptionally high creatine kinase (CK) levels and identify factors contributing to severe massive rhabdomyolysis in the cohort.\"},{\"question\":\"Which substances were most frequently associated with massive rhabdomyolysis in the results?\",\"answer\":\"Recreational drugs, sedatives, and anti-epileptics were the most frequent causative agents.\"},{\"question\":\"How did kidney injury and dialysis needs relate to creatinine differences during hospitalization?\",\"answer\":\"Acute kidney injury occurred in 90%, and 70% required renal replacement therapy. Creatinine concentration differences between days 2 and 1 correlated with hospital stay length, and patients with negative differences did not need dialysis.\"}]","THE CHARACTERISTICS AND OUTCOMES OF TOXIN-INDUCED MASSIVE RHABDOMYOLYSIS | PDF",1790770401,33]