Fatal Outcome Following Polysubstance Use: A Case of Rhabdomyolysis, Acute Renal Failure, and Deep Vein Thrombosis

Polysubstance use, particularly the combination of opioids with stimulants such as cocaine and methamphetamine, is increasingly prevalent and contributes to severe morbidity and mortality. It results in complex clinical consequences, with an expanded spectrum of complications and reduced efficacy of standard emergency interventions. Co-occurring psychiatric disorders and under-recognized systemic injuries beyond primary target organs further complicate patient assessment and management. We report a clinical case of a 37-year-old male with chronic Hepatitis C Virus in-fection and documented polysubstance abuse, including fentanyl, cocaine, metham-phetamine, and cannabis, resulting in fatal complications. The patient developed mas-sive rhabdomyolysis, acute kidney injury with anuria, generalized edema, and left-sided deep vein thrombosis. The clinical course demonstrated rapid progression of multisystem dysfunction, severe electrolyte disturbances, and high-risk metabolic de-rangements. Management included intensive intravenous hydration, diuretic therapy, urinary alkalinization, electrolyte correction, anticoagulation, hemodialysis, and com-prehensive supportive care. This case illustrates the complex pathophysiology of polysubstance toxicity, in which additive and potentially synergistic interactions exacerbate organ damage. Acute rhabdomyolysis emerged as a central mechanism, driven by both sympathomi-metic-induced hypermetabolism and opioid-related immobilization, ultimately precip-itating fatal renal and systemic complications. Despite intensive medical interventions, including hemodialysis, and active family support, the patient’s refusal to continue treatment proved a critical determinant of the fatal outcome. The case underscores the urgent need for effective strategies to manage patients with substance use disorders in acutely life-threatening conditions. It raises the importance of early psychiatric in-volvement, assessment of decision-making capacity, and, where legally justified, tem-porary measures to prevent self-harm resulting from treatment refusal.