Rhabdomyolysis

Abstract

Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle causing myoglobin and other intracellular proteins and electrolytes to leak into the circulation. The development of rhabdomyolysis is associated with a wide variety of diseases, injuries, medications and toxins. While the exact mechanisms responsible for all the causes are not fully understood, it is clear that muscle damage can occur from direct injury or by metabolic inequalities between energy consumption and energy production. Rhabdomyolysis is diagnosed by elevations in serum creatine phosphokinase (CPK), and while there is no established serum level cut-off, many clinicians use five times the upper limit of normal ( approximately 1000 U/l). Rhabdomyolysis can be complicated by acute renal failure (occurring in 4%-33% of patients), compartment syndrome, cardiac dysrhythmias via electrolyte abnormalities, and disseminated intravascular coagulopathy. The mainstay of treatment is hospitalisation with aggressive intravenous fluid (IVF) resuscitation with the correction/prevention of electrolyte abnormalities. There are additional adjunctive therapies to IVF, such as alkalinisation of the urine with sodium bicarbonate, diuretic therapy or combinations of both; however the lack of large randomised control studies concerning the benefits of these treatments makes it difficult to make strong recommendations for or against their use in the treatment of rhabdomyolysis. Regardless of these controversies, the overall prognosis for rhabdomyolysis is favourable when treated with early and aggressive IVF resuscitation, and full recovery of renal function is common. Irrespective of the cause of rhabdomyolysis the mortality rate may still be as high as 8%. This is a comprehensive review of the pathophysiology, diagnosis, complications and treatment options for rhabdomyolysis.

Acute kidney injury caused by decompression illness successfully treated with hyperbaric oxygen therapy and temporary dialysis

“…Myoglobin is a causative agent of renal impairment [14]. Rhabdomyolysis associated with diving could be caused by AGE in skeletal muscles.…”

Iatrogenic AKI and Agranulocytosis: a Cautious Tale of Medication Use in Elderly Patients

“…Rhabdomyolysis is a clinical syndrome characterized by injury to skeletal muscle fibers with disruption and release of their contents into the circulation. Myoglobin, CK and LDH are the most important substances for indicating muscle damage [14]. The clinical symptoms of rhabdomyolysis are well known: myalgia, weakness and swelling involving injured muscles, usually associated with the presence of myoglobin in urine (i.e.…”

Miosite e rabdomiólise na doença mão-pé-boca na infância

“…A partir do diagnóstico de rabdomiólise e sabendo-se que a insuficiência renal aguda é a complicação mais frequente, o primeiro passo no tratamento é a hospitalização, com instituição de hidratação agressiva, prevenção e correção dos distúrbios eletrolíticos. Alcalinização da urina com bicarbonato de sódio também é preconizada (1) . Alguns indicam o uso de diuréticos associados (1) ; entretanto, essa terapia pode agravar o quadro na presença de hipovolemia.…”

“…Alcalinização da urina com bicarbonato de sódio também é preconizada (1) . Alguns indicam o uso de diuréticos associados (1) ; entretanto, essa terapia pode agravar o quadro na presença de hipovolemia. Outros autores sugerem o uso de um esquema composto por bicarbonato e manitol, em conjunto com hidratação para prevenir a insuficiência renal aguda, principalmente em casos de síndrome de esmagamento (16) .…”

“…O diagnóstico tem como base a elevação da creatinafosfoquinase (CPK) e, enquanto não se estabelecer um valor de cut-off definitivo para o diagnóstico, muitos autores adotam o critério de aumento de cinco vezes o limite superior da normalidade (aproximadamente 1.000U/L) (1) . Uma das complicações mais frequentes é a insuficiência renal aguda (IRA), que ocorre em cerca de 4 a 33% dos pacientes, mas também pode haver síndrome compartimental, arritmias cardíacas em decorrência das alterações eletrolíticas e coagulação intravascular disseminada (1) . Entre as causas de rabdomiólise, identificam-se quadros de miosite viral (2) , sendo o agente mais frequentemente associado o vírus influenza, seguido pelo vírus Coxsackie.…”