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Rhabdomyolysis

Summary:


Rhabdomyolysis is a condition that causes rapid death to skeletal muscle tissue.




Contents

What is Rhabdomyolysis?

Rhabdomyolysis is a condition that causes rapid death to skeletal muscle tissue. Breakdown products of damaged muscle is released into the blood stream such as large quantities of potassium, phosphate, myoglobin (protein in muscle cells), creatinine kinase and urea. As a result, this induces several physiological changes in the body that may include hyperkalemia (high level of potassium), hyponatremia (low level of sodium), hypocalcemia (low level of calcium) and hypovolemia (low fluid volume).


Rhabdomyolysis may potentially lead to acute kidney failure. This is due to myoglobin being a larger particle may lead to obstruction of kidney tubule which may cause acute kidney failure.


Besides acute kidney failure, rhabdomyolysis may also cause severe damage to the human body such as fatal heart rhythm disturbances, hypovolemic shock, disturbances of electrolyte balance, metabolic imbalance.


What are the common causes?

The common causes of rhabdomyolysis are:

  1. Traumatic (crush syndrome)
  2. Prolonged immobilization
  3. Marked exertion in untrained individuals
  4. Hyperthermia
  5. Metabolic myopathies
  6. Drugs or toxins
  7. Infections
  8. Electrolyte disorders

In most cases, necrosis is secondary to an infection, drugs cocaine use, excessive exercise, immobilisations, toxins, an injury, or another external cause. Drugs and toxins are the most common causes of necrosis.


What are the signs and symptoms?

People with rhabdomyolysis usually complain of:

  1. Muscle pain and weakness
  2. Generalized malaise, fever
  3. Tachycardia (high heart rate)
  4. Discoloured urine (classic darkening of the urine similar to the colour of tea or Coca-Cola) may be the first indication of muscle injury
  5. Altered mental status can also occur due to electrolyte imbalance


How is rhabdomyolysis diagnosed?

1. Clinical presentations

  • Characterized by pain (potentially severe pain), tenderness, weakness and swelling of the affected muscles

2. Laboratory test

  • Creatinine kinase concentration is the most sensitive and useful indicator of muscle injury
  • Positive urine test for myoglobin
  • A series of blood tests to diagnose complications of rhabdomyolysis such as acute kidney injury


What types of treatment are available?

Medical

Patient with rhabdomyolysis will be managed by aggressive fluid replacement to attain a specific goal of urine output to flush out metabolites to prevent acute kidney failure.

In addition, other management includes correction of electrolyte abnormalities such as hyperkalemia (high level of potassium), and various diuretics (substances that promote production of urine) as well as bicarbonate therapy to prevent myoglobin precipitating in the kidney tubules.

Physiotherapy

Role of rehabilitation is also important to prevent further deconditioning to the body due to prolonged rest. However, it is also important not to overexert the patient to prevent further damage to muscle cells.

Therefore, physiotherapist will advise on the suitable exercises for the patients. The type of exercises may include range of motion exercises to prevent joint stiffness, gradual aerobic activity and gradual resistance training.


References

1. Brudvig T.J. & Fitzgerald P.I. 2007. Identification of signs and symptoms of acute exertional rhabdomyolysis in athletes: A guide for the practitioners. National Strength and Conditioning Association. Volume 29, Number 1, page 10-14

2. Khan F.Y. 2009. Rhabdomyolysis: A review of the literature. Volume 29, Page 9 Huerta-Alardin A.L., Varon J. & Marik P.E. 2005. Bench to bedside review: Rhabdomyolysis- An overview for clinicians. Critical Care. Volume 9, page 158-169

3. Zhang M.H. 2012. Rhabdomyolosys and its pathogenesis. World of J Emergency Med. Volume 3. Number 1.

4. http://www.physio-pedia.com/Rhabdomyolysis

5. http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-rhabdomyolysis?source=search_result&search=rhabdomyolysis&selectedTitle=2~150c

- Last updated 29 May 2014,10:43 am




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