Suspected Compartment Syndrome and Rhabdomyolysis after “Pseudoephedrine” Use: A Case Report


  • Eric Medrano University of Toledo
  • Jake Goliver University of Toledo



Compartment, Syndrome, Rhabdomyolysis, Pseudoephedrine, Toxicology


Acute compartment syndrome and rhabdomyolysis are two life threatening diagnoses that cannot be missed in the emergency room. The increased pressure in the closed compartments of extremities can eventually lead to loss of peripheral pulses, decreased tissue perfusion, and ultimately muscle necrosis. This breakdown of muscle byproducts will ultimately lead to kidney damage and rhabdomyolysis.

Although the most common cause of compartment syndromes are secondary orthopedic causes such as lower extremity fractures there are known documented toxicological causes. (1,2)

Pseudoephedrine, a sympathomimetic amine, is commonly used in the treatment of nasal congestion. Its primary mechanism directly acts on the adrenergic receptor system which stimulates release of stored norepinephrine from neurons. Its alpha-adrenergic effect is believed to be the cause of vasoconstriction in the body (3)

Clinically, intoxication from sympathomimetic drugs have produced toxidromes with prominent features such as tachycardia, hypertension, hyperthermia, agitation, and delirium. However, it is incredibly rare to see an association with pseudoephedrine overdose and rhabdomyolysis and compartment syndrome. There are documented cases where sympathomimetic drugs have been associated with compartment syndrome (2,4,5)

This case of a 29-year-old male with suspected pseudoephedrine abuse highlights the need for consideration of rhabdomyolysis and compartment syndrome being a possible complication from pseudoephedrine overdose.

Author Biography

Jake Goliver, University of Toledo

Jake Goliver, M.D.

Assistant Program Director, University of Toledo Emergency Medicine Residency

2109 Hughes Dr

Promedica Toledo Hospital Campus

Jobst Tower 3rd Floor

Toledo, Ohio 43606



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Roberge, Raymond J., Kamal H. Hirani, Paul L. Rowland III, Ross Berkeley, and Edward P. Krenzelok. "Dextromethorphan-and pseudoephedrine-induced agitated psychosis and ataxia: case report." The Journal of emergency medicine 17, no. 2 (1999): 285-288.

O’Connor, Ayrn D., Angie Padilla-Jones, Richard D. Gerkin, and Michael Levine. "Prevalence of rhabdomyolysis in sympathomimetic toxicity: a comparison of stimulants." Journal of Medical Toxicology 11, no. 2 (2015): 195-200.

Li, Siu Fai, Jennifer Zapata, and Elizabeth Tillem. "The prevalence of false-positive cardiac troponin I in ED patients with rhabdomyolysis." The American journal of Prakash emergency medicine 23, no. 7 (2005): 860-863.

Salmon, J., and D. Nicholson. "DIC and rhabdomyolysis following pseudoephedrine overdose." The American journal of emergency medicine 6, no. 5 (1988): 545-546.

Gülhan, Bora, Benan Bayrakc?, Melih Önder Babao?lu, Burak Bal, and Serdar Beken. "Biphasic creatine kinase elevation in pseudoephedrine overdosage." British journal of clinical pharmacology 67, no. 1 (2009): 139.




How to Cite

Eric Medrano, & Jake Goliver. (2021). Suspected Compartment Syndrome and Rhabdomyolysis after “Pseudoephedrine” Use: A Case Report. Translation: The University of Toledo Journal of Medical Sciences, 9(1).



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