# Heroin Overdose Complicated by Compartment Syndrome, Rhabdomyolysis, and Acute Renal Failure

## TL;DR

A heroin overdose led to severe complications including compartment syndrome, rhabdomyolysis, and acute renal failure in a 38-year-old man.

## Contribution

This case highlights the rare but life-threatening complications of heroin overdose that emergency physicians should be aware of.

## Key findings

- The patient developed acute lower extremity compartment syndrome following a heroin overdose.
- Compartment syndrome was complicated by rhabdomyolysis and acute renal failure.
- Thorough physical exams are critical for identifying life-threatening conditions in overdose patients.

## Abstract

The opioid-abuse epidemic is a problem that continues to persist world-wide. As such, appropriately evaluating and treating such patients is crucial, especially when considering the various complications that may arise. In rare cases, opioid overdoses can be complicated by compartment syndrome, rhabdomyolysis, and acute renal failure. All three of these complications can result in life threatening emergencies.

We present a case of a 38-year-old male who was brought to the emergency department after reportedly being found lying on the ground for an unknown period of time from suspected heroin overdose. He was initially treated with 2 milligrams (mg) of intramuscular naloxone en route via emergency medical services with appropriate response. Shortly after arrival to the emergency department, the patient complained of severe right lower extremity pain, paresthesia and paralysis. Patient developed acute lower extremity compartment syndrome that was further complicated by rhabdomyolysis and acute renal failure.

While emergency medicine physicians are familiar with the common complications of heroin overdose including mental status changes, respiratory depression and gastrointestinal symptoms, they must also be familiar with the less common ones. Notably, acute compartment syndrome. Compartment syndrome is ultimately a clinical diagnosis and warrants emergent surgical consultation. Every patient presenting to the emergency department warrants a complete, thorough physical examination to evaluate for any and all life-threatening conditions, regardless of the presenting complaint.