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. Long-time consumption of narcotics leads to altered mental  status of the addict. It is also connected to damages of different organic  systems and it often leads to appearance of multiple organ failure. Excessive  narcotics consumption or abuse in a long time period can lead to various  consequences, such as atraumatic rhabdomyolysis, acute renal failure and  electrolytic disorders. Rhabdomyolysis is characterized by injury of skeletal  muscle with subsequent release of intracellular contents, such as myoglobin,  potassium and creatine phosphokinase. In heroin addicts, rhabdomyolysis is a  consequence of the development of a compartment syndrome due to  immobilization of patients in the state of unconsciousness and prolonged  compression of extremities, direct heroin toxicity or extremities ischemia  caused by intraluminal occlusion of blood vessels after intraarterial  injection of heroin. Severe hyperkalemia and the development of acute renal  failure require urgent therapeutic measures, which imply the application of  either conventional treatment or a form of dialysis. Case report. We  presented a male patient, aged 50, hospitalized in the Emergency Center  Kragujevac due to altered mental status (Glasgow Coma Score 11), partial  respiratory insufficiency (pO2 7.5 kPa, pCO2 4.3 kPa, SpO2 89 %), weakness of  lower extremities and atypical electrocardiographic changes. Laboratory  analyses, carried out immediately after the patient’s admission to the  Emergency Center, registered the following disturbances: high hyperkalemia  level (K+ 9.9 mmol/L), increased levels of urea (30.1 mmol/L), creatinine  (400 μmol/L), creatine phosphokinase - CK (120350 IU/L), CK-MB (2500 IU/L)  and myoglobin (57000 μg/L), with normal levels of troponin I (< 0.01 μg/L),  as well as signs of anemia (Hgb 92 g/L, Er 3.61 x 1012/L), infection  (C-reactive proteine 184 μg/mL, Le 16.1 x 109/L) and acidosis (base excess -  18.4 mmol/L, pH 7.26. Initial examination of the patient revealed swelling  and paleness of the right lower leg, signs of gangrene of the right foot and  the 1st and the 4th toes of the left foot. The patient had normal values of  arterial pressure (130/80 mmHg) and heart rate (64/min-1); roentgenographic  lungs examination and computerized tomography (CT) brain examination did not  reveal pathological changes in lung and brain parenchyma; toxicological  analyses confirmed the presence of heroin in patient’s organism. The patient  was treated by intensive conventional treatment (infusion of crystalloid  solutions, 8.4% solution of sodium bicarbonate, iv infusion of diuretics,  calcium gluconate and short-acting insulin), and also by antibiotics and  anticoagulants. Normalization of kalemia and fast regression of  electrocardiographic changes were registered. The patient refused the  suggested surgical treatment (fasciotomy, foot amputation). After  stabilization of kidney function and improvement of his mental state, the  patient agreed to undergo surgical procedure. Therefore, on the day 30 of  hospitalization the above-knee amputation of the right leg was performed, and  on the day 38 the transmetatarsal amputation of the left foot was carried  out. After 46 days of hospital treatment, the patient was released and sent  to home treatment. Conclusion. The routine laboratory diagnostics, which  implies determining of the levels of potassium, urea, creatinine and CK in  the serum of all hospitalized heroin addicts can contribute to timely  detection of hyperkalemia and acute kidney weakness and undertaking of  appropriate therapeutic measures

Heroin addict with gangrene of the extremities, rhabdomyolysis and severe hyperkalemia