Acute Renal Failure after Ingestion of Guaifenesin and Dextromethorphan

• Published in: The Journal of emergency medicine 2014-07, Vol.47 (1), p.26-29
• Main Authors: Small, Evan, MD, PhD, Sandefur, Benjamin J., MD
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - chemically induced; Antitussive Agents - adverse effects; dextromethorphan; Dextromethorphan - adverse effects; Emergency; Expectorants - adverse effects; guaifenesin; Guaifenesin - adverse effects; Humans; Male; renal failure; Substance-Related Disorders - complications; ureteral calculi/medication induced; ureteral obstruction; Ureteral Obstruction - chemically induced; Ureteral Obstruction - therapy; Young Adult
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2014.01.022

Abstract Background Guaifenesin is a common nonprescription medication that has been implicated in drug-induced nephrolithiasis. Dextromethorphan, a nonprescription antitussive found in some guaifenesin-containing preparations, is increasingly recognized as a substance of abuse by many youth and young adults. Renally excreted medications known to have poor solubility in urine have the potential to precipitate when ingested in large quantity, leading to acute obstruction of the ureters and renal failure. Objective We describe the case of a 22-year-old male who developed severe bilateral flank pain, hematuria, and oliguria after an isolated recreational ingestion of guaifenesin and dextromethorphan. Case Report The patient was found to have bilateral ureteral obstruction and acute renal failure, suspected to be secondary to precipitation of medication metabolites in the urine. Conclusions This case highlights the potential for acute renal failure secondary to guaifenesin and dextromethorphan abuse.