|Pathophysiology of Rhabdomyolysis|
Potential causes of rhabdomyolysis include:
- Alcohol (Prolonged immobilisation and direct alcohol related toxicity, Low K/Mg/PO4 also predispose)
- Recreational Drug use (Cocaine, Amphetamines, Opoids)
- Medications (Statins, TCAs, SSRIs, Lithium, Steroids, MAOi )
- Myopathies(Dermatomyositis, Polymyositis)
- Trauma (Electricity, Crush Injury)
- Prolonged Immobility (Post Falls in Elderly)
- Infection (Bacterial and Viral)
- Strenuous physical activity
- Heat-related illness.
- Acute onset muscle aches
- Muscle stiffness and weakness
- Dark coloured urine.
- Nausea, vomiting and tachycardia
- Tenderness Muscles
|Pattern of Myoglobin and CK rise during Rhabdomyolysis|
- Treat the underlying cause
- Aggressive Fluid Resuscitation (Normal Saline)
- Target Urine Output is 200-300ml/hr (catheterise to check output in critically ill)
- Treat Hyperkalemia with usual measures
- Avoid Nephrotoxic Medications
- Renal Replacement therapy
- Consider mannitol, especially if compartment syndrome - Low grade evidence
- Early recognition and prompt initiation of treatment is the key
- Pick cues from the history as examinations findings can be subtle or absent
- Watch for the complications (DIC, Compartment Syndrome)
- Parekh R, Care DA, Tainter CR. Rhabdomyolysis: advances in diagnosis and treatment. Emergency medicine practice. 2012 Mar;14(3):1-5.
- Malinoski DJ, Slater MS, Mullins RJ. Crush injury and rhabdomyolysis. Critical care clinics. 2004 Jan 1;20(1):171-92.
- Giannoglou GD, Chatzizisis YS, Misirli G. The syndrome of rhabdomyolysis: pathophysiology and diagnosis. European journal of internal medicine. 2007 Mar 31;18(2):90-100.
- ThomasR:Towardsevidence-basedemergencymedicine: bestBETS from the Manchester Royal Infirmary. Emerg Med J 27: 305, 2010.
- Dalakas MC: Toxic and drug-induced myopathies. J Neurol Neurosurg Psychiatry 80: 832, 2009.
- Clarkson PM, Eichner ER: Exertional rhabdomyolysis: does elevated blood creatine kinase foretell renal failure? Curr Sports Med Rep 5: 57, 2006. [PMID: 16529674]
- Vanholder R, Sever MS, Ekrem E, et al: Rhabdomyolysis. J Am Soc Nephrol 11: 1553, 2000.