Unaccustomed exertion and opiate consumption leading to acute renal failure in a healthy male

A 38 year old male presented with stupor and acute renal failure (ARF) following opium consumption and a protracted excursion on foot to a holy shrine situated at altitude of 4329 m above sea level. The finding of dark colored urine, myoglobinuria and a markedly elevated serum creatinine phosphokinase level supported the diagnosis of rhabdomyolysis. The patient had a rapid and complete recovery following fluid resuscitation and haemodialysis.