Introduction
Rhabdomyolysis is the result of breakdown of muscle tissue, with the subsequent release of muscle products into the bloodstream.
Aetiology
Causes
- Trauma – most common
- Prolonged immobilisation
- Drug reactions – e.g. statins, fibrates, alcohol, ecstacy, heroin, carbon monoxide, neuroleptic malignant syndrome
- Infection – coxackie, EBV, influenza
- Metabolic disorders
- Genetic muscular disorders – e.g. McArdle’s disease, Duchenne’s muscular dystrophy
Pathology
The breakdown of muscle tissue release several products into the blood, including:
Signs & Symptoms
- Often associated with the cause
- Muscle aches
- Oedema
- Red-brown urine
Complications
Investigations
- Bloods
- Urine Dipstick
- +ve for haemoglobin, but absence of red cells on microscopy – due to myoglobin
Treatment
- URGENT – treat hyperkalaemia (if >6.5mmol/L, or ECG changes)
- Untreated, it can cause VENTRICULAR FIBRILLATION
- Other ECG changes include; ‘tented T waves’, flat p waves, increased PR interval, wide QRS – which can get wider and wider, resulting in VT and VF
- Treatment
- IV calcium gluconate – this provides cardioprotection but does not alter serum potassium concentration
- Insulin + glucose – e.g. 20U insulin + 50g glucose 50% IV. Insulin is taken up into cells in conjunction with potassium, thus, serum K is lowered
- Nebulised salbutamol – also moves K into cells
- Polysytrene sulfonate resin – 15g/8h in water, or can be given as an enema if vomiting present (can cause vomiting)
- Dialysis – rarely needed
- IV fluids
- Reduce the risk of ARF
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