Isolated Upper Extremity Compartment Syndrome: A Case of Rhabdomyolysis-induced Myoglobinuria and Acute Kidney Injury after Opioid Overdose

Introduction: The association between rhabdomyolysis secondary to traumatic crush injuries and the resultant acute kidney injury has been well described [1]. The pathway of opioid overdose and acute kidney injury (AKI) has been documented but not fully elucidated [2]. This process is believed to be multifactorial in its pathophysiology, but it remains obscure [2]. Acidosis, systemic hypoxia, hypothermia, muscle compression, immunologic, or direct toxic effects have been identified as contributing factors to opioid-induced AKI [3]. Musculoskeletal crush injuries account for one of the most common causes of rhabdomyolysis leading to AKI [3]. However, the vast majority of crush injuries documented involve large regions of the body and most commonly involve the lower extremity [4]. This is hypothesized to be due to the need for a considerable amount of muscle necrosis and sufficient myoglobinuria to cause AKI [3, 4]. There is a paucity of literature describing isolated upper extremity crush injuries severe enough to cause AKI. The case described herein outlines a patient who developed isolated right upper extremity compartment syndrome and resultant rhabdomyolysis leading to AKI in the setting of an opioid overdose. Case Report: Rhabdomyolysis may be caused by a variety of metabolic events. The pathophysiology of rhabdomyolysis secondary to acute crush injuries with resultant AKI is well documented. However, the literature describing cases of acute kidney injury caused by upper extremity compartment syndrome-induced rhabdomyolysis is limited. We present the case of a 33-year-old male who developed right upper extremity compartment syndrome after being incapacitated following an opioid overdose. He subsequently underwent emergent fasciotomies and was found to have an AKI secondary to rhabdomyolysis in the acute post-operative period. Conclusion: This case describes a patient who was found to have isolated right upper extremity compartment syndrome and subsequent rhabdomyolysis, which resulted in AKI following an opioid overdose. This case highlights that an isolated incidence of upper extremity rhabdomyolysis is sufficient to cause acute kidney injury. The literature describing this pathology in isolated upper extremity injuries is limited as this phenomenon is typically encountered in the setting of lower extremity compartment syndrome. The pathophysiology and mechanism of this pathology are of particular importance to the fields of orthopedic surgery, nephrology, and internal medicine. This case highlights the need for early and adequate fluid resuscitation in patients with isolated upper extremity injuries to minimize the risk of subsequent AKI. Keywords: Compartment syndrome, upper extremity, rhabdomyolysis, acute kidney injury.