Acute kidney injury associated with alcohol and cocaine abuse: A case report

Abstract

Objective: Coabuse of alcohol with cocaine is highly prevalent and the abuse of either drug alone or both in combination have been associated with multiple medical morbidities. Although adverse cardiac, neurological, and psychiatric effects have been extensively described for these psychoactive substances, the potential effects of the concurrent use of cocaine and alcohol on muscle cells, causing severe rhabdomyolysis and potential acute kidney injury have received less attention. The coabuse of these drugs may be particularly problematic in psychiatric patients on powerful psychotropic medications. Methods and Results: We describe a case history of a 41-year-old man with a history of bipolar disorder and alcohol and cocaine use disorder admitted for alcohol detoxification. Soon after admission the patient developed acute kidney injury, presumably secondary to substanceinduced (alcohol and cocaine coabuse) rhabdomyolysis. The patient developed acute renal failure that required admission to acute medical care. His renal failure remitted without dialyses and the patient was discharged to outpatient care. Discussion: Cocaine and alcohol can cause muscle injury. Rhabdomyolysis and acute kidney injury has also been described with a number of psychotropic medications. Furthermore, the concurrent use of these 2 drugs also results in the formation of cocaethylene, a psychoactive and toxic byproduct of the transesterification of cocaine in the liver in the presence alcohol. A significant proposition of patients on psychotropic medications also abuse cocaine and alcohol. Clinicians should be particularly alerted to the possibility of rhabdomyolysis in patients with concurrent cocaine and alcohol abuse, which may be especially relevant in those on psychotropic medications.