[Rhabdomyolysis with life threatening hyperkalemia masquerading as myocardial infarction in acute intentional poisoning with oral morphine (MST)].

A case is described of rhabdomyolysis with life threatening hyperkalemia masquerading as myocardial infarction due to intentional poisoning with oral morphine (M S T 30). A man of 37 y. showed not only the most typical symptoms of opioids intoxication (constricted pupils (miosis), consciousness and ventilation disturbances needing tracheal intubation and long-time i.v. of naloxone infusion) but also rhabdomyolysis with high plasma activity of phosphocreatine kinase (54,000 units) and life threatening hyperkalemia (9.0 mmol/l). An intensive treatment of hyperkalemia was immediately set in simultaneously with i.v. infusion of crystalloids with alkalization. A rapid increase of plasma CPK activity and ecg changes imitating acute myocardial infarction confused the physician about the correctness of the employed therapy excluding the treatment of the supposable myocardial infarction (e.g. thrombolysis). A decrease of calemia to the normal level and the normalization of ecg in the course of the intensive conventional treatment made the physician sure, that the applied remedies against poisoning was sufficient and adequate.