A 42year old female presents with diazepam and alcohol overdose. She is comatose. Temperature is 34.5degC. BP is 100/80 mmHg. Creatinine is 2.4mg/dL, AST -500, GGT- 35 IU. Urine dipstick showed 3+ for blood but urine analysis was normal. USG abdomen was normal. What is the most likely diagnosis?

In the setting of a drug overdose, the patient has presented with hypothermia and deranged kidney function. The keyword in the question is "urine dipstick is 3+ for blood but urine microscopy is normal". This implies that myoglobin in urine is giving a false positive repo for blood detected by urine dipstick. Rhabdomyolysis causes Traumatic crush injuries Alcohol intoxication with prolonged immobility Prolonged seizures activity Excessive exercise Heatstroke Myopathies, drug-induced, metabolic or inflammatory Clinical Manifestations In adults, Rhabdomyolysis is characterized by the triad of: Muscle weakness Myalgia Dark urine Physical findings include muscle tenderness, swelling depending upon the severity of muscle injury. Lab findings include elevation of creatinine kinase. At presentation they are at least five times the upper limit of normal. Myoglobin is not protein bound and hence can easily be detected in urine. Although half life of myoglobin is 2-3 hours and hence at times elevated CK maybe seen in the absence of myoglobinuria. Other manifestations include hepatic dysfunction, AKI, hyperkalemia, hypocalcemia and hyperuricemia( release of purines from damaged muscles)