Severe Amphetamine-Associated Rhabdomyolysis With Dialysis-Requiring Acute Kidney Injury in Two Patients: A Case Report

Amphetamine-associated rhabdomyolysis is an uncommon but potentially life-threatening condition.Massive release of myoglobin and intracellular electrolytes may result in severe metabolic, cardiovascular, and renal complications, particularly acute kidney injury (AKI).We report two cases of severe amphetamine-associated rhabdomyolysis complicated by dialysis-requiring AKI.The first patient, a 46-year-old man, presented with a serum creatine kinase (CK) level of 947,699 U/L, serum creatinine of 734 µmol/L, hyperkalemia of 6.8 mmol/L, and transient left ventricular systolic dysfunction.Management consisted of supportive therapy and eleven sessions of intermittent hemodialysis.The clinical course was complicated by severe delayed hypercalcemia (4.10 mmol/L), followed by cardiac arrest and death.The second patient, a 42-year-old man, presented with a serum CK level of 525,796 U/L, serum creatinine of 544 µmol/L, and hyperkalemia of 7.5 mmol/L.He received supportive treatment and ten sessions of intermittent hemodialysis, resulting in near-complete recovery of renal function.Urine toxicology screening was positive for amphetamines in both patients.Alternative traumatic and nontraumatic causes of rhabdomyolysis were systematically excluded, supporting amphetamine exposure as the most likely explanation for the rhabdomyolysis, based on the clinical presentation, toxicological findings, and exclusion of alternative causes.Amphetamine-associated rhabdomyolysis is a rare but severe cause of AKI that may require renal replacement therapy.These cases highlight the heterogeneous clinical course of amphetamine-associated rhabdomyolysis, ranging from renal recovery to fatal metabolic and cardiovascular complications, and emphasize the importance of early toxicological screening, systematic evaluation of alternative causes of rhabdomyolysis, and prompt multidisciplinary management in patients presenting with myalgia, dark urine, and AKI.