Rhabdomyolysis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

This book describes Rhabdomyolysis, Diagnosis and Treatment and Related Diseases
Rhabdomyolysis is the decomposition (breakdown) of damaged skeletal muscle.
Muscle breakdown causes the discharge of myoglobin into the bloodstream.
Myoglobin is the protein that stocks up oxygen in the muscles.
If a person has too much myoglobin in the blood, it can cause kidney damage.
This would indicate that the kidneys cannot remove waste and concentrated urine.
Infrequently, rhabdomyolysis can even cause death.

Causes:
1. Trauma or crush injuries
2. Use of drugs such as cocaine, amphetamines, statins, heroin, or PCP
3. Genetic muscle diseases
4. Extremes of body temperature
5. Ischemia or death of muscle tissue
6. Low phosphate levels
Symptoms:
1. Muscle weakness,
2. Myalgias, and
3. Dark urine
Other symptoms:
1. Fatigue
2. Joint pain
3. Seizures
4. Weight gain

Diagnosis:
A physical examination will reveal tender or injured skeletal muscles.

These tests may be raised:
1. Creatine kinase (CK) level
2. Serum calcium
3. Serum myoglobin
4. Serum potassium
5. Urinalysis
6. Urine myoglobin test
Imaging studies normally play small part in the early diagnosis of rhabdomyolysis.
Radiographs should be obtained when fractures are suspected.
Computed tomography (CT) of the head may be required on a case-by-case basis when a patient with an altered sensorium is assessed.
Patients with significant head trauma may need head CT.
A head CT scan may also be done in patients with first-time seizure activity or extended seizures or in patients with neurological deficits of unknown cause.
Magnetic resonance imaging (MRI) may be helpful in differentiating various causes of myopathy.
One study indicates that bacterial myositis, focal myositis, and idiopathic rhabdomyolysis show a typical gadolinium enhancement on MRI.
Other tests:
1. ECG should be done early in the course of evaluation to assess for cardiac dysrhythmias related to hyper-kalemia or hypo-calcemia.
2. The compartment pressures must be measured in any patient with serious focal muscle tenderness and a firm muscle compartment.
A fasciotomy may be required if compartment pressures in excess of 25-30 mm Hg are evident.
Histology reveals necrotic muscle fibers in patients with rhabdomyolysis.
3. A muscle biopsy may be required to show immunohistochemical features of necrosis only if underlying and often inherited muscle disease is a problem.
4. Immunoblotting, immunofluorescence, and genetic studies may be required to find evidence of inflammatory conditions or dystrophinopathies

Treatment:
Medical treatment:
1. The doctor should appraise the ABCs (A irway, B reathing, C irculation) and provide supportive care as needed
2. The doctor should ensure adequate hydration, and record urine output.
3. The doctor should identify and correct the inciting cause (e.g., trauma, infection, or toxins)
Support treatment:
1. Correction of electrolyte imbalances
2. Institution of measures to prevent of AKI and acute renal failure (ARF) –
a. Urinary alkalization,
b. Mannitol,
c. Loop diuretics
3. Correction of electrolyte, acid-base, and metabolic abnormalities
4. Serial physical examinations and laboratory studies are indicated to monitor for:
a. Compartment syndrome,
b. Hyper-kalemia,
c. Acute oliguric or nonoliguric renal failure, and
d. Disseminated intravascular coagulation (DIC).
5. Compartment syndrome needs the immediate orthopedic consultation for fasciotomy.
6. DIC treated with:
a. Fresh frozen plasma,
b. Cryoprecipitate, and
c. Platelet transfusions
Surgical treatment:
Fasciotomy in compartment syndrome
Fracture treatment
Acute Kidney Injury and acute renal failure:
Hemodialysis

TABLE OF CONTENT
Introduction
Chapter 1 Rhabdomyolysis
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Compartment Syndrome
Chapter 8 Crush Injury
Epilogue