Severe rhabdomyolysis and respiratory failure occurred after exposure to monensin- a case report and literature review

Abstract Background: Cases of human monensin toxicosis are rare. Symptoms such as rhabdomyolysis and severe respiratory failure may occur after exposure to monensin. Case presentation: A 44-year-old male worker in a pharmaceutical factory complained of generalized muscle pain, muscular weakness, and dark brown colored urine. His creatine kinase (CK) value was as high as 69881IU/L. Aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) was significantly increased, suggesting a high possibility of rhabdomyolysis. During the hospitalization, the patient developed severe respiratory failure and was relieved after receiving bilevel positive airway pressure (BiPAP) ventilation and a large amount of fluids, methylprednisolone, sodium bicarbonate, and other treatments. His muscle biopsy showed that enzymatic activities of cytochrome C oxidase (COX) and succinate dehydrogenase（SDH）were partially absent. After treatment with hormones, urine alkalization, nutritional therapy of mitochondria, and fully rehydration, the patient's symptoms were relieved. Conclusions: Early attention and intervention are needed for rhabdomyolysis and severe respiratory failure caused by monensin.