Hyperthermia and Rhabdomyolysis in Self‐Poisoning with Paracetamol and Salicylates

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Abstract
A young woman ingested large amounts of different analgesics, mainly salicylate and paracetamol. On admission about 17 h later, clearly toxic serum levels of both drugs were demonstrated. She was comatose with respiratory failure for 5 days. During the 1st day there was a period of several hours of therapy-resistant hyperthermia. A severe bleeding tendency was probably related to profound coagulation defects. Persisting elevated serum levels of ASAT [asparagine aminotransferase] and ALAT [alanine aminotransferase] for 2 wk were presumably caused by a toxic effect of paracetamol on the liver. When consciousness was regained, widespread pareses of skeletal muscles, predominantly of the lower limbs, were demonstrated. These were related to extensive rhabdomyolysis as evidenced by extremely elevated serum levels of CPK [creatine phosphokinase] for 6 wk, and by muscle necrosis in biopsy specimens. There was a gradual improvement, but walking disturbances were present after 1 yr. The hyperthermia was probably related to the cerebral effects of salicylates or the combination of multiple drugs. The rhabdomyolysis might be related to a deleterious effect of hyperthermia on the muscles or to an effect of paracetamol on the skeletal muscles similar to that which might occur in the myocardium, or to a combination of these mechanisms.