Dextromethorphan-induced serotonin syndrome leading to rhabdomyolysis and dialysis-requiring acute kidney injury: a case report and review

Abstract

Abstract Background Dextromethorphan (DXM) misuse, particularly among young individuals, has risen owing to its euphoric and hallucinogenic effects. High-dose DXM ingestion can trigger serotonin syndrome, a condition characterized by psychiatric, neuromuscular, and autonomic symptoms. In severe cases, serotonin syndrome may result in rhabdomyolysis and acute kidney injury (AKI). However, reports of severe DXM-induced serotonin syndrome requiring dialysis are exceedingly rare. Case presentation We report the case of a Japanese man in his 20s who developed serotonin syndrome after consuming approximately 1800 mg of DXM. He presented with agitation, hyperthermia, and neuromuscular symptoms, fulfilling the Hunter criteria for serotonin syndrome. Despite sedation with midazolam, agitation persisted, necessitating intubation and deep sedation with propofol. The patient developed rhabdomyolysis and AKI, requiring kidney replacement therapy. Dialysis was discontinued on hospital day 20, and the patient was discharged by hospital day 26. Subsequently, 4 months after discharge, a decreased serum creatinine level of 1.04 mg/dL was detected. Conclusions This case highlights the potential for severe, life-threatening complications, such as rhabdomyolysis and dialysis-requiring AKI, following DXM monotherapy, even in the absence of concomitant medications. Raising public awareness of the risks associated with over the counter DXM misuse is crucial, especially considering the increasing rates of overdose among young individuals.

Keywords

• Dextromethorphan
• Serotonin syndrome
• Rhabdomyolysis
• Acute kidney injury
• Kidney replacement therapy