Randy L. Howard, MD; William D. Kaehny, MD
To the Editor: Herzlich and colleagues reported three cases of rhabdomyolysis related to cocaine use (1). We would like to comment on two aspects of their report. The evidence supporting "the ability of cocaine to produce rhabdomyolysis" is insufficient. Also, the statement that myoglobinuria is characterized by heme-positive urine with either no erythrocytes or a minimal number of erythrocytes may be misleading.
The list of reported causes for rhabdomyolysis is long, but includes compression, ethanol ingestion, and seizures as the commonest causes (2). To show a direct relation between cocaine use and rhabdomyolysis, at least these causes must be excluded.
Howard RL, Kaehny WD. Cocaine and Rhabdomyolysis. Ann Intern Med. ;110:90–91. doi: 10.7326/0003-4819-110-1-90
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Published: Ann Intern Med. 1989;110(1):90-91.
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