Rhabdomyolysis: an unusual complication following diclofenac and amitraz consumption

Amitraz is a pesticide with central alpha 2 agonistic action and diclofenac non- steroidal anti-inflammatory drug. Rhabdomyolysis not commonly associated either compound consumption. We report the case of 28-year-old male who after presenting to us following 25ml amitraz consumption, developed diffuse myalgia, muscle tenderness, cola coloured urine oliguric acute renal failure which was followed by altered sensorium. Further probing revealed that he had also consumed 10 tablets unknown dose tablet along amitraz. suspected confirmed an elevated creatinine phosphokinase. He hydrated IV fluids, given bicarbonate N-acetylcysteine in view deteriorating function underwent 6 sessions hemodialysis. Following same, sensorium improved, output normalised, improved phosphokinase levels showed decreasing trend indicating reduction rhabdomyolysis. In poisoning cases it often difficult reliably confirm drug at time presentation. Therefore, like our case, addition initial supportive measures, periodic review history, examination, regular monitoring vitals timely appropriate blood investigations can help nature poison detect early possible complications, thus enable initiation life saving treatment patient outcomes.