Abstract Objective Rhabdomyolysis is associated with methamphetamine, amphetamine, and methylenedioxymethamphetamine (MA) use. The aim of this study was to determine the frequency, severity, and risk factors of rhabdomyolysis associated with MA use. Methods: We reviewed patients with an MA-positive toxicology screen with and without diagnosed rhabdomyolysis based on initial creatine kinase (CK) concentration over a period of 6 years. Demographics, vital signs, disposition, diagnoses, and laboratory results were recorded. Results: There were 7,319 patients with an MA-positive toxicology screen, of whom 957 (13%) were screened for rhabdomyolysis and included in the study. The majority were male, White, and middle-aged and smoked tobacco. Psychiatric (34%), neurological (15%), and trauma (13%) were the most common discharge diagnostic groups. The majority (55%) were admitted, and 8% were discharged to an inpatient psychiatric facility. Concomitant substance use included ethanol (10%) and cocaine (8%), and 190 (20%) had rhabdomyolysis with median (interquartile range) CK of 2,610 (1,530–6,212) U/L and range 1,020 to 98,172 U/L. There was significant difference in renal function between the rhabdomyolysis and non-rhabdomyolysis patients. Other differences included gender and troponin I concentration. A higher proportion of patients screening positive for both MA and cocaine use experienced rhabdomyolysis. Multiple logistic regression analysis revealed elevated troponin I, blood urea nitrogen, and/or creatinine concentration and male gender to be significant factors associated with rhabdomyolysis. Conclusions: The frequency of rhabdomyolysis in patients screening positive for MA was 20%. Factors associated with rhabdomyolysis in MA-positive patients included elevated troponin, blood urea nitrogen, creatinine concentration, and male gender. Clinicians caring for patients who screen positive for MA should also consider concomitant rhabdomyolysis, especially if renal/cardiac laboratory tests are abnormal and even if there is no history of injury, agitation, or physical restraint.

中文翻译：

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横纹肌溶解症、甲基苯丙胺、苯丙胺和摇头丸的使用：相关因素和风险

摘要 目的横纹肌溶解症与甲基苯丙胺、苯丙胺和亚甲二氧基甲基苯丙胺 (MA) 的使用有关。本研究的目的是确定与 MA 使用相关的横纹肌溶解的频率、严重程度和危险因素。方法：我们根据 6 年内的初始肌酸激酶 (CK) 浓度评估了 MA 阳性毒理学筛查诊断为横纹肌溶解症或未诊断为横纹肌溶解症的患者。记录人口统计学、生命体征、处置、诊断和实验室结果。结果：共有 7,319 名 MA 阳性毒理学筛查患者，其中 957 名 (13%) 接受横纹肌溶解筛查并纳入研究。大多数是男性、白人以及吸烟的中年人。精神科 (34%)、神经科 (15%) 和外伤 (13%) 是最常见的出院诊断组。大多数 (55%) 入院，8% 出院到住院精神病院。伴随物质使用包括乙醇 (10%) 和可卡因 (8%)，190 (20%) 名横纹肌溶解，中位（四分位距）CK 为 2,610 (1,530-6,212) U/L，范围为 1,020 至 98,172 U/L。横纹肌溶解症和非横纹肌溶解症患者的肾功能存在显着差异。其他差异包括性别和肌钙蛋白 I 浓度。较高比例的 MA 和可卡因使用筛查阳性患者经历了横纹肌溶解症。多元逻辑回归分析显示，肌钙蛋白 I、血尿素氮和/或肌酐浓度升高和男性是与横纹肌溶解相关的重要因素。结论：在 MA 筛查阳性的患者中横纹肌溶解的发生率为 20%。与 MA 阳性患者横纹肌溶解相关的因素包括肌钙蛋白、血尿素氮、肌酐浓度和男性的升高。照顾 MA 筛查阳性患者的临床医生也应考虑伴随横纹肌溶解，尤其是在肾/心脏实验室检查异常的情况下，即使没有受伤、激动或身体束缚的病史。