LETTER TO THE EDITOR
Year : 2014 | Volume
: 4 | Issue : 3 | Page : 271-
Acute rhabdomyolysis: Cook in soup
Subramanian Senthilkumaran1, Shah Sweni2, Namasivayam Balamurugan1, Ponniah Thirumalaikolundusubramanian3,
1 Department of Emergency and Critical Care, Sri Gokulam Hospitals and Research Institute, Salem, India
2 Department of Emergency and Critical Care, Sri Gokulam Hospitals and Research Institute, Salem; Department of Internal Medicine, Chennai Medical College Hospital and Research Center, Trichy, Tamil Nadu, India
3 Department of Internal Medicine, Chennai Medical College Hospital and Research Center, Trichy, Tamil Nadu, India
Department of Emergency and Critical Care Medicine, Sri Gokulam Hospital and Research institute, Salem-636 004, Tamil Nadu
|How to cite this article:|
Senthilkumaran S, Sweni S, Balamurugan N, Thirumalaikolundusubramanian P. Acute rhabdomyolysis: Cook in soup.Int J Crit Illn Inj Sci 2014;4:271-271
|How to cite this URL:|
Senthilkumaran S, Sweni S, Balamurugan N, Thirumalaikolundusubramanian P. Acute rhabdomyolysis: Cook in soup. Int J Crit Illn Inj Sci [serial online] 2014 [cited 2019 Nov 20 ];4:271-271
Available from: http://www.ijciis.org/text.asp?2014/4/3/271/141490
Liquefied petroleum gas (LPG) is a colorless liquefied gas composed of light chain aliphatic hydrocarbons, which is mainly composed of butane and propane, mixed in varying proportions.  Toxic effects of LPG and its components on various organs are well reported.  However, LPG-induced rhabdomyolysis is rarely reported.  Here, we report a case of rhabdomyolysis due to leak from the LPG cylinder.
A 55-year-old male working as cook came to the emergency department with complaints of weakness, painful swelling of the leg, and passing 'brown' urine since morning. They also gave history of recent onset of headache, neck pain, myalgia, and a sense of fever. There was no history of seizure, altered sensorium, fever, intake of anti-inflammatory drugs, trauma, use of illicit drugs or herbal medications, and recent ingestion of fish or any birds. Past medical history and family history were not contributory.
On examination, he was conscious, well oriented, and afebrile, without any pallor or pedal edema. His vitals were stable and systemic examination was unremarkable. There was no tenderness in any muscles of the body on palpation except the swollen legs, i.e., both legs R (right) > L (left). Arterial blood gas showed metabolic acidosis. His hematology profile was within normal range, but his blood chemistry such as blood urea nitrogen (BUN) 35 mg/dl, creatinine (Cr) 1.5 mg/dl, sodium (Na + ) 138 mEq/l, and potassium (K + ) of 6 mEq/l were altered. The serum lactate dehydrogenase (LDH), alanine transaminase (ALT), and aspartate aminotransferase (AST) levels were 498, 347, and 1,205 IU/l, respectively. His total calcium (Ca 2+ ), ionized Ca 2+ , magnesium (Mg 2+ ), and phosphate (PO 4 ) levels were. 6.5, 1.6, 1.2, and 4.2, respectively. The D-dimer was negative. Creatinine phosphokinase (CPK) was 27,000 IU/dl (normal range 30-170 IU/dl). Creatine kinase MB (CKMB) isoform was normal. Troponin T was negative. Urine yielded positive dipstick for blood and negative microscopy for red blood cells (RBCs). Urine myoglobin was positive and serum myoglobin was 319 ng/ml (normal 19-92 ng/ml). Chest X-ray and electrocardiography (ECG) were normal. Both limbs were subjected for venous Doppler, which was negative for deep vein thrombosis (DVT). He was managed with alkaline diuresis to maintain urine output of 250 ml/h and improved symptomatically without any complication.
Butane and propane are simple asphyxiants that replace oxygen in the ambient air in an enclosed area. The prolonged inhalation of LPG may produce myonecrosis due to inadequate oxygen delivery that pushes the metabolism toward anaerobic respiration. The myotoxicity can be attributed to the direct toxic and oxidant effects of LPG. Inhalational exposure is known to cause various effects on the heart including myocardial infarction, ventricular tachycardia/fibrillation, and asystole.  This accident was due to a leak from a corrosive pit in a worn out old LPG cylinder that was kept in a poorly ventilated room. Ethyl mercaptan is used as odorants in LPG for safety reasons and it provides a characteristic "rotten cabbage" smell; however, this distinctive odor cannot be detected by all people under all circumstances. Immediate diagnosis, early fluid resuscitation, and intense (fluid, electrolyte and cardiac) monitoring prevent other complications of rhabdomyolysis. Occupational safety measures need to be taught and followed.
|1||McKee RH, Herron D, Saperstein M, Podhasky P, Hoffman GM, Roberts L. The toxicological properties of petroleum gases. Int J Toxicol 2014;33:28-51S.|
|2||Fukunaga T, Yamamoto H, Tanegashima A, Yamamoto Y, Nishi K. Liquefied petroleum gas (LPG) poisoning: Report of two cases and review of literature. Forensic Sci Int 1996;82:193-200.|
|3||Prasad S, Singh R, Manocha R, Narang M, Sharma BD, Rajwanshi P, et al. Acute massive rhabdomyolysis due to inhalation of LPG. J Assoc Physicians India 2009;57:472-3.|
|4||Senthilkumaran S, Meenakshisundaram R, Michaels AD, Balamurgan N, Thirumalaikolundusubramanian P. Ventricular fibrillation after exposure to air freshener-death just a breath away. J Electrocardiol 2012;45:164-6.|