SHM Converge Scientific Abstract ePoster Gallery-Unexplained Rhabdomyolysis in a Hospital-at-Home Patient

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This case describes a 75-year-old woman enrolled in UNC’s Advanced Care at Home hospital-at-home program who presented with jaw and right gluteal pain and was found to have rhabdomyolysis (CK 2330 U/L). Initial imaging showed no cellulitis or abscess, and the cause was unclear on admission, so she was treated at home with IV fluids and lab monitoring.<br /><br />The diagnosis became apparent only after the care team entered her home and performed a detailed medication reconciliation. They discovered that she was taking two atorvastatin prescriptions simultaneously (20 mg and 40 mg daily) and often took extra doses because she could not remember whether she had already taken them. The team also found that she was consuming at least three grapefruits per day and had exhausted her amoxicillin/clavulanate early, supporting medication mismanagement. Her recent increase in furosemide may have contributed through dehydration, and her cirrhosis may have increased susceptibility.<br /><br />Her rhabdomyolysis was attributed to accidental statin overuse combined with grapefruit-statin interaction, likely worsened by dehydration and liver disease. She improved with four lactated Ringer boluses, and her CK declined to 727 U/L by discharge. To prevent recurrence, her statin was stopped, her daughter was enlisted to remove old medications and manage pill boxes, and her primary care physician was notified for ongoing monitoring.<br /><br />The key takeaway is that hospital-at-home can reveal important home-based factors—such as medication duplication, adherence problems, and diet—that may be missed in a traditional hospital setting.

Asset Subtitle

Patrick M. O'Shea

Meta Tag

Author List Dana Kouchel, Jeffrey Chou, Kristi Scruggs, Michael Craig, Patrick M. O'Shea

Category Clinical Vignettes

Concept Rhabdomyolysis

Concept Medication Toxicity

Concept Statin

Concept Medication Reconciliation

Concept Grapefruit

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Patrick M. O'Shea

Track Adult

Keywords

rhabdomyolysis

atorvastatin overdose

grapefruit interaction

hospital-at-home

medication reconciliation

statin toxicity

dehydration

cirrhosis

polypharmacy

medication mismanagement

Rhabdomyolysis

Medication Toxicity

Statin

Medication Reconciliation

Grapefruit