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Rhabdomyolysis
| Rhabdomyolysis | |
|---|---|
 | |
| Urine from a person with rhabdomyolysis showing the characteristic brown discoloration as a result of myoglobinuria | |
| Pronunciation | |
| Specialty | Critical care medicine, nephrology |
| Symptoms | Muscle pains, weakness, vomiting, confusion, tea-colored urine, irregular heartbeat[3][4] |
| Complications | Kidney failure, high blood potassium, low blood calcium, disseminated intravascular coagulation, compartment syndrome[3] |
| Causes | Crush injury, strenuous exercise, medications, substance use, certain infections[3] |
| Diagnostic method | Blood test (creatine kinase), urine test strip[3][5] |
| Treatment | Intravenous fluids, dialysis, hemofiltration[3] |
| Frequency | 26000 reported cases per year (U.S.)[3] |
Rhabdomyolysis (shortened as rhabdo) is a condition in which damaged skeletal muscle breaks down rapidly, often due to high intensity exercise over a short period.[6][4][5] Symptoms may include muscle pains, weakness, vomiting, and confusion.[3][4] There may be tea-colored urine or an irregular heartbeat.[3][5] Some of the muscle breakdown products, such as the protein myoglobin, are harmful to the kidneys and can cause acute kidney injury.[7][3]
The muscle damage is most usually caused by a crush injury, strenuous exercise, medications, or a substance use disorder.[3] Other causes include infections, electrical injury, heat stroke, prolonged immobilization, lack of blood flow to a limb, or snake bites[3] as well as intense or prolonged exercise, particularly in hot conditions.[8] Statins (prescription drugs to lower cholesterol) are considered a small risk.[9] Some people have inherited muscle conditions that increase the risk of rhabdomyolysis.[3] The diagnosis is supported by a urine test strip which is positive for "blood" but the urine contains no red blood cells when examined with a microscope.[3] Blood tests show a creatine kinase activity greater than 1000 U/L, with severe disease being above 5000–15000 U/L.[5]
The mainstay of treatment is large quantities of intravenous fluids.[3] Other treatments may include dialysis or hemofiltration in more severe cases.[4][10] Once urine output is established, sodium bicarbonate and mannitol are commonly used but they are poorly supported by the evidence.[3][4] Outcomes are generally good if treated early.[3] Complications may include high blood potassium, low blood calcium, disseminated intravascular coagulation, and compartment syndrome.[3]
Rhabdomyolysis is reported about 26,000 times a year in the United States.[3] While the condition has been commented on throughout history, the first modern description was following an earthquake in 1908.[11] Important discoveries as to its mechanism were made during the Blitz of London in 1941.[11] It is a significant problem for those injured in earthquakes, and relief efforts for such disasters often include medical teams equipped to treat survivors with rhabdomyolysis.[11]
- ^ "Rhabdomyolysis". Merriam-Webster.com Dictionary. Merriam-Webster.
- ^ "Rhabdomyolysis". Dictionary.com Unabridged (Online). n.d.
- ^ a b c d e f g h i j k l m n o p q r Sauret JM, Marinides G, Wang GK (March 2002). "Rhabdomyolysis". American Family Physician. 65 (5): 907–912. PMID 11898964.
- ^ a b c d e Huerta-Alardín AL, Varon J, Marik PE (April 2005). "Bench-to-bedside review: Rhabdomyolysis -- an overview for clinicians". Critical Care. 9 (2): 158–169. doi:10.1186/cc2978. PMC 1175909. PMID 15774072.
- ^ a b c d Chavez LO, Leon M, Einav S, Varon J (June 2016). "Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice". Critical Care. 20 (1): 135. doi:10.1186/s13054-016-1314-5. PMC 4908773. PMID 27301374.
- ^ "What is Rhabdo? | NIOSH | CDC". www.cdc.gov. 3 December 2021. Retrieved 15 December 2022.
- ^ Kodadek L, Carmichael Ii SP, Seshadri A, Pathak A, Hoth J, Appelbaum R, Michetti CP, Gonzalez RP (2022). "Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document". Trauma Surg Acute Care Open. 7 (1): e000836. doi:10.1136/tsaco-2021-000836. PMC 8804685. PMID 35136842.
- ^ Oh RC, Bury DC, McClure CJ (November 2022). "Exertional rhabdomyolysis: an analysis of 321 hospitalised US military service members and its relationship with heat illness". BMJ Military Health: e002028. doi:10.1136/military-2021-002028. PMID 36442890. S2CID 254067955. Retrieved 6 July 2023.
- ^ Cite error: The named reference
Sathasivamwas invoked but never defined (see the help page). - ^ Bosch X, Poch E, Grau JM (July 2009). "Rhabdomyolysis and acute kidney injury". The New England Journal of Medicine. 361 (1): 62–72. doi:10.1056/NEJMra0801327. PMID 19571284. S2CID 4652812.
- ^ a b c Vanholder R, Sever MS, Erek E, Lameire N (August 2000). "Rhabdomyolysis". Journal of the American Society of Nephrology. 11 (8): 1553–1561. doi:10.1681/ASN.V1181553. PMID 10906171.
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