- Rhabdomyolyisis
- Breakdown of striated muscle
- Final common pathway includes a rapid increase in intracellular calcium causing release of myocyte constituents into the blood
- Causes
- Traumatic
- Crush/trauma
- Excessive muscle activity
- Electrocution
- Non-traumatic
- Infection
- Bacterial polymyositis
- Legionella
- Tetanus
- Electrolyte abnormalities
- Hypokalaemia
- Hypocalcaemia
- Hypophosphataemia
- Hyponatraemia
- Immune
- Dermatomyositis
- Polymyositis
- Drugs
- Alcohol
- Statins
- Cocaine
- Anaesthetic agents (MH)
- Management
- Prompt fluid resuscitation
- Urine alkalisation with 1.26% bicarbonate
- Aim for urinary pH of 7
- Some advocate the use of mannitol
- May need haemofiltration
- Good prognosis with full recovery expected in 3/12 in the majority of patients
- Myoglobin which is released from the cells is a haem-containing molecule which causes tubular obstruction, renal vasoconstriction and may be directly toxic to the tubules
- CK levels are usually 5x normal; 5000u/L or above is associated with 50% risk of ARF
- Hypocalcaemia commonly seen in early rhabdo. As cells lyse, hyperkalaemia, hyperuricaemia, hyperphosphatameia, hypercalcaemia and acidosis can occur
- Clinical presentation
- Depends on cause
- Muscle pain
- Weakness
- Hypovolaemic shock
- ARF
- Dark urine
- Fever
- Tachycardia
- CEACCP
Link:ceaccp.oxfordjournals.org/content/6/4/141.full.pdf