False elevation of serum creatinine following skin absorption of nitromethane complicates the clinical diagnosis of rhabdomyolysis.

Abstract

A patient had extensive blunt trauma from a high-speed crash in which nitromethane fuel erupted from the fuel tank and soaked into his protective multilayer jumpsuit. The clinical diagnosis was complicated because the absorption of nitromethane fuel through the skin and by inhalation falsely increased the serum creatinine value when a modified Jaffe reaction was used in the laboratory. This spurious value was "unmasked" by the use of an enzymatic method to measure the serum creatinine level. A high serum creatinine value disproportionate to the level of BUN and recent skin exposure to nitromethane were the clinical indications that suggested the differentiation of massive rhabdomyolysis from spurious hypercreatinemia. This spurious value was a confounding factor in the diagnosis of crush syndrome and rhabdomyolysis.