Rhabdomyolysis Caused by a Behavioral Manifestation of Acute Mania

Abstract Introduction While seen in patients with bipolar disorder due to NMS, antipsychotic side effects, or substance use, rhabdomyolysis resulting from behaviors mania has not been reported recent literature. We present a case of patient exertion during manic episode. Case A 29-year-old male history type 1 was brought the ED June 2022 after he found on roof local theater sharing excerpts book had written. Temperatures outside were 100–102 Fahrenheit. On presentation, rapid, pressured speech and demonstrated flight ideas. He religiously preoccupied. previously admitted Psychiatric Emergency Services April for discharged lithium lamotrigine. titrating these medications his outpatient psychiatrist. The patient’s labs showed an elevated creatinine 1.49, up baseline 1.09. Further workup revealed CK 3,538. Additional abnormalities included AST 70, calcium 10.6, total bilirubin 1.6, WBC 15.5. afebrile, oriented, no obvious signs infection. received 2 liters Lactated Ringers (LR) Internal Medicine. Later, agitated overnight 10mg olanzapine 2mg lorazepam. Lithium level following fluid resuscitation 0.6. interview next day, described working creative religious piece that wanted share others, leading him climbing roof. hyper-focused this work, 1–4 hours sleep nightly. also frequently doing gymnastics, walking long distances, other buildings. endorsed diffuse muscle pain, but reproducible exam. 150mL/hr LR started, PO intake encouraged. agreed resume started 900mg lamotrigine 50mg. His continued downtrend. count decreased 12.9 at discharge. Lamotrigine titrated home dose 100mg. improved, ultimately follow-up. Conclusion Rhabdomyolysis results release toxic cellular compounds fibers. Complications include acute renal failure, hyperkalemia, compartment syndrome. Causes medications, trauma, seizures, ischemia, overexertion, dehydration. Recently cases mania-associated involve iatrogenic causes, such as neuromuscular malignant syndrome (NMS) non-NMS effects.Other causes high-risk drug use mania. behavioral manifestations have documented more rarely older reports, similarly, addressing excessive exercise Therefore, our represents reminder medical sequalae actions undertaken This highlights importance implementing effective treatment prevent episodes. Funding No