{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T01:03:32Z","timestamp":1792371812579,"version":"4.4.0"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T00:00:00Z","timestamp":1615420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>This study was conducted to retrospectively assess the relationships between: rhabdomyolysis (quantified by creatine kinase (CK) activity) and kidney injury (quantified by serum creatinine concentration), sex, age, body temperature on admission, presence of seizures, and agitation or aggression in patients presenting to the Emergency Department with acute recreational drug toxicity. We also investigated the association with the substances ingested.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>All presentations to the 16 sentinel Euro-DEN centres in 10 European countries with acute recreational drug toxicity during the first year of the Euro-DEN study (October 2013 to September 2014) were considered. Cases that had abnormal CK activity recorded as part of routine clinical care were divided into 3 cohorts depending on peak CK activity. Cases with normal CK activity were included as a control group (4<jats:sup>th<\/jats:sup> cohort).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Only 1,015 (18.4%) of the 5,529 Euro-DEN presentations had CK activity concentration recorded. Of this group 353 (34.8%) had also creatinine concentration measured. There were 375 (36.9%) with minor rhabdomyolysis, 69 (6.8%) with moderate rhabdomyolysis, and 24 (2.4%) with severe rhabdomyolysis; 547 (53.9%) were included in the control group. There was a positive correlation between CK activity and creatinine concentration (correlation coefficient r = 0.71, p&lt;0.0001). There was no correlation between CK activity and body temperature at the time of presentation to the ED (correlation coefficient r = 0.07, p = 0.03). There was a positive correlation between CK activity and length of stay in the hospital (r = 0.31, p&lt;0.001). There was no association between CK activity and the presence of seizures (p = 0.33) or agitation\/aggression (p = 0.45), patients age (p = 0.4) or sex (p = 0.25). The 5 most common agents amongst patients presenting with rhabdomyolysis were: cocaine (n = 107; 22.9% presentations), amphetamine (76; 16.2%), cannabis (74; 15.8%), GHB\/GBL (72; 15.4%) and heroin (67; 14.3%). The distribution of rhabdomyolysis in 5 most common drugs was (drug; patients with rhabdomyolysis, patients without rhabdomyolysis): cocaine (107, 122), cannabis (74, 117), GHB\/GBL (72, 81), amphetamine (76, 66), heroin (67, 70).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Abnormal values of CK activity occurred in almost half (46.1%) of presentations to the Emergency Department with acute recreational drug toxicity in whom CK activity was measured; however, severe rhabdomyolysis is seen in only a small minority (2.4%). Those with rhabdomyolysis are at significantly higher risk of kidney injury and have a longer length of hospital stay.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0246297","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T18:36:11Z","timestamp":1615487771000},"page":"e0246297","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":24,"title":["Rhabdomyolysis related to acute recreational drug toxicity\u2014A Euro-DEN study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7986-8539","authenticated-orcid":true,"given":"Wojciech","family":"Waldman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9711-348X","authenticated-orcid":true,"given":"Piotr M.","family":"Kabata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison M.","family":"Dines","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Yates","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fridtjof","family":"Heyerdahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Knut Erik","family":"Hovda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Giraudon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Euro-DEN Research Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul I.","family":"Dargan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7258-8558","authenticated-orcid":true,"given":"Jacek","family":"Sein Anand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,3,11]]},"reference":[{"key":"pone.0246297.ref001","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1136\/bmj.1.4185.427","article-title":"Crush Injuries with Impairment of Renal Function","volume":"1","author":"EG Bywaters","year":"1941","journal-title":"Br Med J. BMJ Publishing Group"},{"key":"pone.0246297.ref002","first-page":"612","article-title":"Experimental crushing injury","volume":"75","author":"EGL Bywaters","year":"1942","journal-title":"Surg Gynecol Obs"},{"key":"pone.0246297.ref003","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1001\/jama.289.13.1681","article-title":"Statin-associated myopathy","volume":"289","author":"PD Thompson","year":"2003","journal-title":"Jama. American Medical Association"},{"key":"pone.0246297.ref004","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/S0196-0644(95)70218-0","article-title":"Severe rattlesnake envenomation with anaphylaxis and rhabdomyolysis","volume":"25","author":"SP Bush","year":"1995","journal-title":"Ann Emerg Med. Elsevier"},{"key":"pone.0246297.ref005","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1580\/1080-6032(1999)010[0247:NAWSSP]2.3.CO;2","article-title":"Neurotoxicity associated with suspected southern Pacific rattlesnake (Crotalus viridis helleri) envenomation","volume":"10","author":"SP Bush","year":"1999","journal-title":"Wilderness Environ Med. Elsevier"},{"key":"pone.0246297.ref006","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.annemergmed.2004.06.018","article-title":"Case report: compartment syndrome after a suspected black widow spider bite","volume":"45","author":"J Cohen","year":"2005","journal-title":"Ann Emerg Med. Elsevier"},{"key":"pone.0246297.ref007","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1016\/S0196-0644(05)81518-5","article-title":"Predicting the severity of cocaine-associated rhabdomyolysis","volume":"19","author":"SL Brody","year":"1990","journal-title":"Ann Emerg Med. Elsevier"},{"key":"pone.0246297.ref008","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S0735-6757(99)90159-6","article-title":"Methamphetamine abuse and rhabdomyolysis in the ED: a 5-year study","volume":"17","author":"JR Richards","year":"1999","journal-title":"Am J Emerg Med. Elsevier"},{"key":"pone.0246297.ref009","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1056\/NEJM198809153191103","article-title":"Acute rhabdomyolysis associated with cocaine intoxication","volume":"319","author":"D Roth","year":"1988","journal-title":"N Engl J Med"},{"key":"pone.0246297.ref010","doi-asserted-by":"crossref","first-page":"321","DOI":"10.3109\/15563659008994433","article-title":"Rhabdomyolysis and acute renal failure associated with cocaine abuse","volume":"28","author":"PC Singhal","year":"1990","journal-title":"J Toxicol Clin Toxicol. Taylor & Francis"},{"key":"pone.0246297.ref011","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/S0196-0644(05)81215-6","article-title":"Incidence of cocaine-associated rhabdomyolysis","volume":"20","author":"RD Welch","year":"1991","journal-title":"Ann Emerg Med"},{"key":"pone.0246297.ref012","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/S0964-3397(97)80056-0","article-title":"Ecstasy-induced rhabdomyolysis and its role in the development of acute renal failure","volume":"13","author":"M Cunningham","year":"1997","journal-title":"Intensive Crit care Nurs. Elsevier"},{"key":"pone.0246297.ref013","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1093\/jurban\/79.4.549","article-title":"The \u201cecstasy\u201d hangover: hyponatremia due to 3, 4-methylenedioxymethamphetamine","volume":"79","author":"SJ Traub","year":"2002","journal-title":"J Urban Heal. Springer"},{"key":"pone.0246297.ref014","first-page":"230","article-title":"Some Aspects of Intoxication with Tricholoma equestre","volume":"49","author":"J Sein Anand","year":"2011","journal-title":"Clin Toxicol"},{"key":"pone.0246297.ref015","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1097\/01.md.0000188565.48918.41","article-title":"Rhabdomyolysis: an evaluation of 475 hospitalized patients","volume":"84","author":"G Melli","year":"2005","journal-title":"Medicine (Baltimore)"},{"key":"pone.0246297.ref016","doi-asserted-by":"crossref","first-page":"525","DOI":"10.5144\/0256-4947.1998.525","article-title":"Drug-induced rhabdomyolysis","volume":"18","author":"EB Larbi","journal-title":"Ann Saudi Med"},{"key":"pone.0246297.ref017","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/00000441-200308000-00005","article-title":"The other medical causes of rhabdomyolysis","volume":"326","author":"RC Allison","year":"2003","journal-title":"Am J Med Sci. Elsevier"},{"key":"pone.0246297.ref018","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1002\/mus.10053","article-title":"Rhabdomyolysis: a review","volume":"25","author":"J Warren","year":"2002","journal-title":"Muscle Nerve"},{"key":"pone.0246297.ref019","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1136\/pgmj.69.811.333","article-title":"Drug-induced rhabdomyolysis\u2014mechanisms and management","volume":"69","author":"BD Prendergast","year":"1993","journal-title":"Postgrad Med J"},{"key":"pone.0246297.ref020","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1038\/ki.1996.48","article-title":"Rhabdomyolysis and myohemoglobinuric acute renal failure","volume":"49","author":"RA Zager","year":"1996","journal-title":"Kidney Int. Elsevier"},{"issue":"7","key":"pone.0246297.ref021","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.3390\/ijms20071561","article-title":"Molecular Toxicological Mechanisms of Synthetic Cathinones on C2C12 Myoblasts","volume":"20","author":"X. Zhou","year":"2019","journal-title":"International Journal of Molecular Sciences"},{"key":"pone.0246297.ref022","doi-asserted-by":"crossref","first-page":"893","DOI":"10.3109\/15563650.2015.1088157","article-title":"Acute recreational drug and new psychoactive substance toxicity in Europe: 12 months data collection from the European Drug Emergencies Network (Euro-DEN)","volume":"53","author":"AM Dines","year":"2015","journal-title":"Clin Toxicol"},{"key":"pone.0246297.ref023","unstructured":"Final Report of the European Drug Emergencies Network (Euro\u2014DEN) March 2015. 2015."},{"key":"pone.0246297.ref024","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2016"},{"key":"pone.0246297.ref025","doi-asserted-by":"crossref","DOI":"10.1007\/978-0-387-98141-3","volume-title":"ggplot2: Elegant Graphics for Data Analysis","author":"H Wickham","year":"2009"},{"key":"pone.0246297.ref026","unstructured":"Wickham H, Francois R. dplyr: A Grammar of Data Manipulation [Internet]. 2016. https:\/\/cran.r-project.org\/package=dplyr."},{"key":"pone.0246297.ref027","unstructured":"Auguie B. gridExtra: Miscellaneous Functions for \u2018Grid\u2019 Graphics [Internet]. 2016. https:\/\/cran.r-project.org\/package=gridExtra."},{"key":"pone.0246297.ref028","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v021.i12","article-title":"Reshaping Data with the reshape Package","volume":"21","author":"H Wickham","year":"2007","journal-title":"J Stat Softw"},{"issue":"3","key":"pone.0246297.ref029","first-page":"205","article-title":"Poisoning severity score. Grading of acute poisoning","volume":"36","author":"H. E. Persson","journal-title":"Journal of Toxicology: Clinical Toxicology"},{"key":"pone.0246297.ref030","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0736-4679(00)00180-3","article-title":"Rhabdomyolysis and drugs of abuse","volume":"19","author":"JR Richards","year":"2000","journal-title":"J Emerg Med"},{"key":"pone.0246297.ref031","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.disamonth.2008.10.002","article-title":"Cocaine: History, Social Implications, and Toxicity\u2014A Review","volume":"55","author":"RA Goldstein","year":"2009","journal-title":"Disease-a-Month"},{"key":"pone.0246297.ref032","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.annemergmed.2012.01.005","article-title":"Hyperthermia and multiorgan failure after abuse of \u2018bath salts\u2019 containing 3,4-methylenedioxypyrovalerone","volume":"60","author":"HA Borek","year":"2012","journal-title":"Ann Emerg Med"},{"key":"pone.0246297.ref033","first-page":"534","article-title":"Gamma-hydroxy-butyrate (GHB) and gamma-butyrolactone (GBL): analysis of overdose cases reported to the Swiss Toxicological Information Centre","volume":"134","author":"ME Liechti","year":"2004","journal-title":"Swiss Med Wkly"},{"key":"pone.0246297.ref034","first-page":"206","article-title":"Reply: Rhabdomyolysis and drugs of abuse","volume":"135","author":"ME Liechti","year":"2005","journal-title":"Swiss Med Wkly"},{"issue":"43\u201344","key":"pone.0246297.ref035","first-page":"652","article-title":"Acute medical problems due to Ecstasy use. Case-series of emergency department visits","volume":"135","author":"M. E. Liechti","year":"2005","journal-title":"Swiss medical weekly"},{"key":"pone.0246297.ref036","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.jemermed.2011.03.008","article-title":"Use of RIFLE criteria to predict the severity and prognosis of acute kidney injury in emergency department patients with rhabdomyolysis","volume":"42","author":"KA Delaney","year":"2012","journal-title":"J Emerg Med"},{"key":"pone.0246297.ref037","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0736-4679(00)00180-3","article-title":"Rhabdomyolysis and drugs of abuse","volume":"19","author":"JR Richards","year":"2000","journal-title":"J Emerg Med"},{"key":"pone.0246297.ref038","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1111\/acem.12385","article-title":"Characteristics and thirty-day outcomes of emergency department patients with elevated creatine kinase","volume":"21","author":"BE Grunau","year":"2014","journal-title":"Acad Emerg Med"},{"key":"pone.0246297.ref039","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1093\/ndt\/9.6.637","article-title":"Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis","volume":"9","author":"J Veenstra","year":"1994","journal-title":"Nephrol Dial Transplant"},{"key":"pone.0246297.ref040","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.2298\/VSP1311039J","article-title":"Causes of rhabdomyolysis in acute poisonings","volume":"70","author":"SR Jankovi\u0107","year":"2013","journal-title":"Vojnosanit Pregl"},{"key":"pone.0246297.ref041","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/00005792-198205000-00002","article-title":"The spectrum of rhabdomyolysis","volume":"61","author":"PA Gabow","year":"1982","journal-title":"Medicine (Baltimore)"},{"key":"pone.0246297.ref042","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1001\/archinte.1988.00380070059015","article-title":"Factors predictive of acute renal failure in rhabdomyolysis","volume":"148","author":"MM Ward","year":"1988","journal-title":"Arch Intern Med"},{"key":"pone.0246297.ref043","doi-asserted-by":"crossref","first-page":"467","DOI":"10.3109\/08860229509037610","article-title":"The clinical and biochemical features of acute renal failure due to rhabdomyolysis","volume":"17","author":"G Woodrow","year":"1995","journal-title":"Ren Fail"},{"key":"pone.0246297.ref044","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1097\/01.TA.0000130761.78627.10","article-title":"Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference?","volume":"56","author":"CVR Brown","year":"2004","journal-title":"J Trauma"},{"key":"pone.0246297.ref045","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1007\/s00134-003-1800-5","article-title":"Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey","volume":"29","author":"AR de Meijer","year":"2003","journal-title":"Intensive Care Med"},{"key":"pone.0246297.ref046","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajem.2004.09.025","article-title":"Factors predictive of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis","volume":"23","author":"WG Fernandez","year":"2005","journal-title":"Am J Emerg Med"},{"key":"pone.0246297.ref047","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1055\/s-0029-1220252","article-title":"\u201eLiquid Ecstasy\u201d: Gamma-Butyrolacton-Entzugsdelir mit Rhabdomyolyse und dialysepflichtiger Niereninsuffizienz","volume":"134","author":"A Supady","year":"2009","journal-title":"DMW\u2014Dtsch Medizinische Wochenschrift"},{"issue":"5","key":"pone.0246297.ref048","doi-asserted-by":"crossref","first-page":"e9784","DOI":"10.1097\/MD.0000000000009784","article-title":"Acute recreational drug toxicity: Comparison of self-reports and results of immunoassay and additional analytical 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