Rhabdomyolysis and renal failure following overdose: two illustrative cases

Introduction Overdoses of certain drugs may lead to rhabdomyolysis with a risk of acute renal failure. Mechanisms include direct drug toxicity or positional ischaemia from highly sedating drugs. Both conditions carry significant morbidity and mortality, warranting prompt recognition and intervention.Case Report Case 1: A 79-year-old woman overdosed on amitriptyline and citalopram, presenting with a Glasgow Coma Score (GCS) of 7, widened QRS interval, hypotension, and acidosis. Management included sodium bicarbonate, dialysis, and treatment of sciatic nerve palsy from compartment syndrome. She recovered fully with no ongoing dialysis requirement. Case 2: A 37-year-old man overdosed on heroin, presenting with severe opiate toxidrome and aspiration pneumonitis. The complications included anuric renal failure, recurrent hypoglycaemia, and rhabdomyolysis. Despite treatment with naloxone, acetylcysteine, and continuous renal replacement therapy (CRRT), the patient remained dialysis-dependent at discharge.Discussion These cases reinforce the need for serial assessment for rhabdomyolysis and renal failure in poisoned patients, particularly those who are obtunded or intubated. Early recognition and management can reduce morbidity.