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  • Rhabdomyolysis Atf

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    Manoj Bhatt
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    Rhabdomyolysis is a syndrome caused by muscle necrosis that can lead to renal failure and death. It is caused by intense physical exercise, especially if dehydrated, crush injuries, and certain drugs like statins. A key marker is elevated creatine kinase levels. Muscle breakdown releases myoglobin, potassium, phosphate, and purines which can cause renal toxicity if not treated with IV fluids and electrolyte management. Symptoms include muscle pain, weakness, and dark urine from myoglobin.

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    Rhabdomyolysis is a syndrome caused by muscle necrosis that can lead to renal failure and death. It is caused by intense physical exercise, especially if dehydrated, crush injuries, and certain drugs like statins. A key marker is elevated creatine kinase levels. Muscle breakdown releases myoglobin, potassium, phosphate, and purines which can cause renal toxicity if not treated with IV fluids and electrolyte management. Symptoms include muscle pain, weakness, and dark urine from myoglobin.

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    © All Rights Reserved
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    12 views16 pages

    Rhabdomyolysis Atf

    Uploaded by

    Manoj Bhatt
    Rhabdomyolysis is a syndrome caused by muscle necrosis that can lead to renal failure and death. It is caused by intense physical exercise, especially if dehydrated, crush injuries, and certain drugs like statins. A key marker is elevated creatine kinase levels. Muscle breakdown releases myoglobin, potassium, phosphate, and purines which can cause renal toxicity if not treated with IV fluids and electrolyte management. Symptoms include muscle pain, weakness, and dark urine from myoglobin.

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    of 16

    AfraTafreeh.

    com

    Rhabdomyolysis
    Jason Ryan, MD, MPH
    Rhabdomyolysis
    • Syndrome caused by muscle necrosis
    • Can lead to renal failure and death

    AfraTafreeh.com

    OpenStax College
    AfraTafreeh.com

    Rhabdomyolysis
    Causes of Muscle Damage

    • Intense physical exercise


    • Especially if dehydrated
    • Crush injuries (trauma)
    • Drugs
    • Statins
    • Fibrates
    Muscle Contents
    • Creatine kinase
    • Elevated levels are hallmark of rhabdomyolysis
    • Aldolase, lactate dehydrogenase, AST/ALT

    AfraTafreeh.com
    AfraTafreeh.com

    Muscle Contents
    • Potassium and phosphate
    • Hyperkalemia/hyperphosphatemia in rhabdomyolysis

    19 15
    K P
    Muscle Contents
    • Purines
    • Metabolized to uric acid in liver
    • Can lead to hyperuricemia

    AfraTafreeh.com

    Adenine Guanine
    AfraTafreeh.com

    Myoglobin
    • Protein monomer (NOT tetramer like Hgb)
    • Contains heme (porphyrin plus iron)
    • Binds oxygen for use by muscle tissue

    Wikipedia/Public Domain
    Myoglobin
    100

    75
    % Saturation

    AfraTafreeh.com
    50 No allosteric interactions!

    25

    25 50 75 100

    pO2 (mmHg)
    AfraTafreeh.com

    Myoglobin
    Renal Toxicity

    • Obstructs tubules
    • Toxic to proximal tubular cells
    • Vasoconstriction
    • Especially in medulla
    • Leads to renal hypoxia

    Image courtesy of Piotr Michał Jaworski


    Myoglobin
    Renal Toxicity

    • Made worse by volume depletion in rhabdomyolysis


    • Intravascular fluid influx into muscle tissue
    • Feared outcome rhabdomyolysis: renal failure/death

    AfraTafreeh.com

    Pixabay/Public Domain
    AfraTafreeh.com

    Rhabdomyolysis
    Symptoms

    • Muscle pain
    • Weakness
    • Dark urine (from myoglobin)

    James Heilman, MD/Wikipedia


    Rhabdomyolysis
    Diagnosis

    • Creatine kinase
    • Usually very high
    • Normal < 250 IU/L
    • Rhabdomyolysis > 1000 IU/L
    • Sometimes up to 25,000 or more IU/L
    AfraTafreeh.com
    AfraTafreeh.com

    Rhabdomyolysis
    Diagnosis

    • Urinalysis for heme


    • Heme has peroxidase activity
    • Breaks down peroxide
    • Changes test strip color
    • Positive dipstick = hemoglobin or myoglobin

    Image courtsy of J3D3


    Rhabdomyolysis
    Diagnosis

    • Microscopy for red blood cells


    • Classic finding rhabdomyolysis
    • Dark urine
    • Positive dipstick for heme
    • No evidence of red blood cells
    AfraTafreeh.com

    Image courtsy of Bobjgalindo


    AfraTafreeh.com

    Rhabdomyolysis
    Treatment

    • Volume resuscitation
    • IV Fluids (usually isotonic saline)
    • Titrated to maintain good urine output
    • Treatment of electrolyte abnormalities
    • Dialysis
    Hypocalcemia
    • Calcium deposits in damaged myocytes
    • Initial phases rhabdomyolysis: hypocalcemia
    • Recovery phase: release from myocytes
    • Levels return to normal
    • Can become elevated AfraTafreeh.com

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