methamphetamine ( ma ) is used as a recreational drug for its properties which cause sense of energy and euphoria . the same amount of ma may not cause harm in some individuals , however , it also may be seriously toxic for some other individuals . ma may cause hepatotoxicity , rhabdomyolysis , cardiotoxicity , nephrotoxicity , and neurotoxicity separately or sometimes together as multisystem toxicity , mostly as a serious condition requiring hospitalization . nephrotoxicity generally presents as acute kidney injury , hyponatremia , and hypertension 1 , 2 , 3 . a 32yearold male was admitted to our facility with muscle weakness , pain , and a 1 day history of oliguria . he had a history of ma abuse 3 years ago and used the same substance orally 1 week prior to admission . physical examination revealed acidotic breathing , paleness and bruises of the skin in the lumbar region . laboratory findings on admission included creatinine kinase ( ck ) 15,000 u / l , lactate dehydrogenase ( ldh ) 1509 u / l , urea 284 mg / dl , creatinine 8.06 mg / dl , aspartate transaminase 456 u / l , alanine transaminase 753 u / l , and sodium 131 mmol / l , potassium 6.7 meq / l . he was diagnosed with rhabdomyolysis and acute kidney injury , and intravenous hydration treatment with isotonic saline solution was begun , based on urine output . however , because of his continuing uremic status and hyperkalemia , he underwent five rounds of hemodialysis ( hd ) . following bed rest , carbohydrate predominant diet , adequate fluid resuscitation , and hd , the clinical status and laboratory parameters improved significantly over the next 12 days of hospitalization ( fig . 1 ) . creatinine kinase and lactate dehydrogenase survey of the patient during follow up . many systems , including especially the nervous system , may be pathologically affected due to these substances . ma generally damages dopaminergic and serotonergic nerves in central nervous system and this contributes its high abuse potential 4 . in addition to cardiovascular and neurological effects , ma abuse may result in hyperpyrexia , hyponatremia , rhabdomyolysis , disseminated intravascular coagulopathy , gastrointestinal bleeding , hepatic failure , and renal failure . mainduced renal injury possibly occurs due to traumatic rhabdomyolysis , necrotizing vasculitis , urinary tract obstruction , hypertension , proximal tubule dysfunction , and volume depletion 5 , 6 . in our case , rhabdomyolysis , acute kidney injury , hepatotoxicity , and neurotoxicity emerged after the use of ma in the acute period . after the discontinuation of the agent and appropriate treatment with hydration and hd , our patient improved significantly . in conclusion , physicians should be aware that multisystem toxicity may develop as a result of ma use and clinical suspicion , early diagnosis , and appropriate treatment may be life saving .
key clinical messagemethamphetamine ( ma ) may cause hepatotoxicity , rhabdomyolysis , acute kidney injury , and neurotoxicity separately or together . 
 we report a patient admitted with muscle weakness , pain , and oliguria 1 week after ma use ; requiring repeated hemodialysis ( hd ) . 
 multisystem toxicity may develop as a result of ma use and appropriate treatment may be life saving .