Rhabdomyolysis: Difference between revisions
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== Diagnostic Tests/Lab Tests/Lab Values == | == Diagnostic Tests/Lab Tests/Lab Values == | ||
== Causes == | |||
Causes for rhabdomyolysis can be broken down into 2 categories, hereditary causes and acquired causes. | Causes for rhabdomyolysis can be broken down into 2 categories, hereditary causes and acquired causes. | ||
'''Hereditary Causes''' | === '''Hereditary Causes''' === | ||
Those that are at risk for rhabdomyolysis have a family history of disorders dealing with carbohydrate metabolism as well as disorders of lipid metabolism.<span style="mso-spacerun: yes"> </span>Disorders of lipid metabolism include malignant hyperthermia, mitochondrial disorders, as well as other genetic disorders. | Those that are at risk for rhabdomyolysis have a family history of disorders dealing with carbohydrate metabolism as well as disorders of lipid metabolism.<span style="mso-spacerun: yes"> </span>Disorders of lipid metabolism include malignant hyperthermia, mitochondrial disorders, as well as other genetic disorders. | ||
'''Acquired Causes''' | === '''Acquired Causes''' === | ||
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. | 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. | ||
<br> | <br> | ||
Below is a chart that describes the risk factors for rhabdomyolysis as well as examples of the risk factors and associated signs and symptoms.<span style="mso-spacerun: yes"> </span> <!--EndFragment--> <br> <!--StartFragment--> | Below is a chart that describes the risk factors for rhabdomyolysis as well as examples of the risk factors and associated signs and symptoms.<span style="mso-spacerun: yes"> </span> <!--EndFragment--> <br> <!--StartFragment--> | ||
<div>[[Image:Screen shot 2010-03-05 at 7.34.16 PM.png|center|Image:Screen_shot_2010-03-05_at_7.34.16_PM.png]]<br></div> | |||
<div><br></div> | === <span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;font-weight:bold;vertical-align:baseline;mso-text-raise:0%"></span>'''Risk Factors For Postoperative Rhabdomyolysis''' === | ||
<div class="O0" style="margin-top:0pt;margin-bottom:0pt;margin-left:.38in; text-indent:-.38in" | <div class="O0" style="margin-top:0pt;margin-bottom:0pt;margin-left:.38in; text-indent:-.38in"><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;font-weight:bold;vertical-align:baseline;mso-text-raise:0%">Preoperative</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Male</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Age > 10 years</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">BMI > 55 kg/m2</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">History of hypertension, | ||
diabetes mellitus, or peripheral vascular disease</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">History of statin use</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">elevated preoperative serum | diabetes mellitus, or peripheral vascular disease</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">History of statin use</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">elevated preoperative serum | ||
CPK level</span></div> <div class="O0" style="margin-top:0pt;margin-bottom:0pt;margin-left:.38in; text-indent:-.38in" | CPK level</span></div> <div class="O0" style="margin-top:0pt;margin-bottom:0pt;margin-left:.38in; text-indent:-.38in"><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;font-weight:bold;vertical-align:baseline;mso-text-raise:0%">Intraoperative</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Operation duration > 5hours</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Anesthesia time > 6 hours</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Inadequate hydration</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Urine output < 1.5ml/kg/h</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Bleeding and/or hypotension</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Use of propofol and/or | ||
succinylcholine</span></div> <div class="O0" style="margin-top:0pt;margin-bottom:0pt;margin-left:.38in; text-indent:-.38in" | succinylcholine</span></div> <div class="O0" style="margin-top:0pt;margin-bottom:0pt;margin-left:.38in; text-indent:-.38in"><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;font-weight:bold;vertical-align:baseline;mso-text-raise:0%">Postoperative</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Complaints of muscle pain and | ||
weakness</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Delayed ambulation</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Urine otuput <1.5mL/kg/h</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Serum CPK > 1,000IU/L</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Urine myoglobin > 250m g/L</span></div> <!--EndFragment--> | weakness</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Delayed ambulation</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Urine otuput <1.5mL/kg/h</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Serum CPK > 1,000IU/L</span></div> <div class="O1" style="margin-top:0pt;margin-bottom:0pt;margin-left:.81in; text-indent:-.31in"><span><span style="mso-special-format:bullet">•</span></span><span style="font-family:Cambria;mso-ascii-font-family:Cambria;mso-fareast-font-family: +mn-ea;mso-bidi-font-family:+mn-cs;color:black;mso-color-index:13;language: en-US;vertical-align:baseline;mso-text-raise:0%">Urine myoglobin > 250m g/L</span></div> <!--EndFragment--> | ||
Revision as of 02:43, 6 March 2010
Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
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]
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Prevalence[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
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Associated Co-morbidities[edit | edit source]
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Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[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]
Preoperative
•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
Intraoperative
•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
Postoperative
•Complaints of muscle pain and
weakness
•Delayed ambulation
•Urine otuput <1.5mL/kg/h
•Serum CPK > 1,000IU/L
•Urine myoglobin > 250m g/L
Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic 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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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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