Rhabdomyolysis: Difference between revisions
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=== <font class="Apple-style-span" size="3"><span class="Apple-style-span" style="font-size: 13px; font-weight: normal;"><font class="Apple-style-span" size="5"><span class="Apple-style-span" style="font-size: 18px; font-weight: 800;">Risk Factors For Postoperative Rhabdomyolysis</span></font></span></font> === | === <font class="Apple-style-span" size="3"><span class="Apple-style-span" style="font-size: 13px; font-weight: normal;"><font class="Apple-style-span" size="5"><span class="Apple-style-span" style="font-size: 18px; font-weight: 800;">Risk Factors For Postoperative Rhabdomyolysis</span></font></span></font> === | ||
<font class="Apple-style-span" size="3"><span class="Apple-style-span" style="font-size: 13px; font-weight: normal;"><font class="Apple-style-span" size="5"><span class="Apple-style-span" style="font-size: 18px; font-weight: 800;"></span></font></span></font> <!--StartFragment--> <div class="O0" style="margin-top:0pt;margin-bottom:0pt;margin-left:.38in; | <font class="Apple-style-span" size="3"><span class="Apple-style-span" style="font-size: 13px; font-weight: normal;"><font class="Apple-style-span" size="5"><span class="Apple-style-span" style="font-size: 18px; font-weight: 800;"></span></font></span></font> | ||
text-indent:-.38in"><u><span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | <!--StartFragment--> <div class="O0" style="margin-top:0pt;margin-bottom:0pt;margin-left:.38in; text-indent:-.38in"><u><span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;font-weight:bold;vertical-align:baseline;mso-text-raise:0%">Preoperative</span></u></div> | ||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">Male</span> | ||
language:en-US;font-weight:bold;vertical-align:baseline;mso-text-raise:0%">Preoperative</span></u></div> | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">Age > 10 years</span> | ||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">BMI > 55 kg/m2</span> | ||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">History of | ||
language:en-US;vertical-align:baseline;mso-text-raise:0%">Male</span> | </span>hypertension, diabetes mellitus, or peripheral vascular disease | ||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | |||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">History of statin use</span> | ||
language:en-US;vertical-align:baseline;mso-text-raise:0%">Age > 10 years</span> | *<span style="color: black; vertical-align: baseline;">E</span><span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">levated preoperative | ||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | </span>serum CPK level | ||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | <div class="O0" style="margin-top:0pt;margin-bottom:0pt;margin-left:.38in; text-indent:-.38in"><u><span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;font-weight:bold;vertical-align:baseline;mso-text-raise:0%">Intraoperative</span></u></div> | ||
language:en-US;vertical-align:baseline;mso-text-raise:0%">BMI > 55 kg/m2</span> | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">Operation duration | ||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | </span>> 5hours | ||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | |||
language:en-US;vertical-align:baseline;mso-text-raise:0%">History of | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">Anesthesia time > | ||
hypertension, diabetes mellitus, or peripheral vascular disease | </span>6 hours | ||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | |||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">Inadequate hydration</span> | ||
language:en-US;vertical-align:baseline;mso-text-raise:0%">History of statin use</span> | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">Urine output < | ||
*<span style="color: black; vertical-align: baseline; ">E</span><span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | </span>1.5ml/kg/h | ||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | |||
language:en-US;vertical-align:baseline;mso-text-raise:0%">levated preoperative | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">Bleeding and/or | ||
</span>hypotension | |||
<div class="O0" style="margin-top:0pt;margin-bottom:0pt;margin-left:.38in; | |||
text-indent:-.38in"><u><span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">Use of propofol | ||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | </span>and/or succinylcholine | ||
language:en-US;font-weight:bold;vertical-align:baseline;mso-text-raise:0%">Intraoperative</span></u></div> | <div class="O0" style="margin-top:0pt;margin-bottom:0pt;margin-left:.38in; text-indent:-.38in"><u><span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;font-weight:bold;vertical-align:baseline;mso-text-raise:0%">Postoperative</span></u></div> | ||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">Complaints of muscle | ||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | </span>pain and weakness | ||
language:en-US;vertical-align:baseline;mso-text-raise:0%">Operation duration | |||
> 5hours | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">Delayed ambulation</span> | ||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">Urine output | ||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | </span><1.5mL/kg/h | ||
language:en-US;vertical-align:baseline;mso-text-raise:0%">Anesthesia time > | |||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">Serum CPK > | |||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | </span>1,000IU/L | ||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | |||
language:en-US;vertical-align:baseline;mso-text-raise:0%">Inadequate hydration</span> | *<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; language:en-US;vertical-align:baseline;mso-text-raise:0%">Urine myoglobin > | ||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | </span>250m g/L <!--EndFragment--> | ||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | |||
language:en-US;vertical-align:baseline;mso-text-raise:0%">Urine output < | |||
1.5ml/kg/h | |||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | |||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | |||
language:en-US;vertical-align:baseline;mso-text-raise:0%">Bleeding and/or | |||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | |||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | |||
language:en-US;vertical-align:baseline;mso-text-raise:0%">Use of propofol | |||
and/or succinylcholine | |||
<div class="O0" style="margin-top:0pt;margin-bottom:0pt;margin-left:.38in; | |||
text-indent:-.38in"><u><span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | |||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | |||
language:en-US;font-weight:bold;vertical-align:baseline;mso-text-raise:0%">Postoperative</span></u></div> | |||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | |||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | |||
language:en-US;vertical-align:baseline;mso-text-raise:0%">Complaints of muscle | |||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | |||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | |||
language:en-US;vertical-align:baseline;mso-text-raise:0%">Delayed ambulation</span> | |||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | |||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | |||
language:en-US;vertical-align:baseline;mso-text-raise:0%">Urine | |||
<1.5mL/kg/h | |||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | |||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | |||
language:en-US;vertical-align:baseline;mso-text-raise:0%">Serum CPK > | |||
1,000IU/L | |||
*<span style="font-family:Helvetica;mso-ascii-font-family:Helvetica;mso-fareast-font-family: | |||
+mn-ea;mso-bidi-font-family:Helvetica;color:black;mso-color-index:13; | |||
language:en-US;vertical-align:baseline;mso-text-raise:0%">Urine myoglobin > | |||
250m g/L | |||
<!--EndFragment--> | |||
== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == |
Revision as of 22:00, 6 March 2010
Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Definition/Description
[edit | edit source]
Rhabdomyolysis is the breakdown of skeletal muscle tissue that occurs quickly due to a large release of creatinine phosphokinase enzymes due to mechanical, physical, or chemical traumatic injuries.Patho Due to the quick breakdown of the skeletal muscle there is a big accumulation of the breakdown products which can cause renal failure.patho
Historical Background[edit | edit source]
Prevalence[edit | edit source]
Pathophysiology[edit | edit source]
Causes[edit | edit source]
Causes for rhabdomyolysis can be broken down into 2 categories, hereditary causes and acquired causes.
Hereditary Causes[edit | edit source]
Those that are at risk for rhabdomyolysis have a family history of disorders dealing with carbohydrate metabolism as well as disorders of lipid metabolism. Disorders of lipid metabolism include malignant hyperthermia, mitochondrial disorders, as well as other genetic disorders.
Acquired Causes[edit | edit source]
Some of the most common acquired causes include trauma or crush injury, toxic, sever muscle exertion, seizures, shaking chills, delerium tremors, ischemia or muscle necrosis, metabolic disorders, bacterial and viral infections, heat-induced (malignant hyperthermia, heat intolerance, heat stroke), inflammatory, certain drugs (overuse or overdose) such as cocaine, amphetamines, statins, heroin, PCP, as well as low phosphate levels.
Below is a chart that describes the risk factors for rhabdomyolysis as well as examples of the risk factors and associated signs and symptoms.
Risk Factors For Postoperative Rhabdomyolysis[edit | edit source]
- Male
- Age > 10 years
- BMI > 55 kg/m2
- History of
hypertension, diabetes mellitus, or peripheral vascular disease
- History of statin use
- Elevated preoperative
serum CPK level
- Operation duration
> 5hours
- Anesthesia time >
6 hours
- Inadequate hydration
- Urine output <
1.5ml/kg/h
- Bleeding and/or
hypotension
- Use of propofol
and/or succinylcholine
- Complaints of muscle
pain and weakness
- Delayed ambulation
- Urine output
<1.5mL/kg/h
- Serum CPK >
1,000IU/L
- Urine myoglobin >
250m g/L
Characteristics/Clinical Presentation[edit | edit source]
add text here
Associated Co-morbidities[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
Blood samples are takenfrom the patient to look at various serum values, one of the most important serum indicators of myocyte injury is creatinine kinase.ef
Creatinine Kinase
“ Under normal conditions, CK levels are 45-260 U/L. After rhabdomyolysis, the levels of CK can be raised to 10.000-200.000 U/L or even 3.000.000.000 U/L. No other condition except rhabdomyolysis can cause such extreme CK elevation.”Ef Creatine Kinase has several forms that include the muscles, heart, brain and kidneys, as well as mitochndria so it is important to look at all values.
Uric Acid
Uric Acid is important to check due to the fact that rhabdomyolysis breaks down skeletal muscle creating more creatinine, which then becomes creatinine which can then lead to acute renal failure, therefore causing the levels of uric acid to rise.
UrinalysisUrine analysis can be very helpful in diagnosing rhabdomyolysis. Urinalysis will be able to detect changes in the body’s waste, such as increases in uric acid, albumin, as well as myoglobin.ef Often patients that are positive for rhabdomyolysis have brown tinted urine. Table 3 has a description of common findings in urinalysis.
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Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
Medications[edit | edit source]
Physical Therapy Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports[edit | edit source]
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