Rhabdomyolysis

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.

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Definition/Description

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Prevalence

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Characteristics/Clinical Presentation

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Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Causes

Causes for rhabdomyolysis can be broken down into 2 categories, hereditary causes and acquired causes.

Hereditary Causes<o:p></o:p>

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<o:p></o:p>

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.

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Below is a chart that describes the risk factors for rhabdomyolysis as well as examples of the risk factors and associated signs and symptoms.   

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width="443" colspan="3" valign="top" style="width:6.15in;border:solid windowtext 1.0pt; border-bottom:none;mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt: solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;background: white;mso-background-themecolor:background1;padding:0in 5.4pt 0in 5.4pt" | Risk Factors for Rhabdomyolysis<o:p></o:p> <o:p> </o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#365F91;mso-background-themecolor: accent1;mso-background-themeshade:191;padding:0in 5.4pt 0in 5.4pt" | Risk Factors for Rhabdomyolysis<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#365F91; mso-background-themecolor:accent1;mso-background-themeshade:191;padding:0in 5.4pt 0in 5.4pt" | Examples<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#365F91;mso-background-themecolor: accent1;mso-background-themeshade:191;padding:0in 5.4pt 0in 5.4pt" | Signs and Symptoms<o:p></o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Trauma<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Crush injury<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Profound muscle weakness<o:p></o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Electric Shock<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Pain<o:p></o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Severe Burns<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Swelling<o:p></o:p>
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width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | ·      Nausea, vomiting<o:p></o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | ·      Agitation, confusion<o:p></o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Extreme Muscular Activity<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Strenuous exercise<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>
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width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Cocaine<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Amphetamines<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Ectasy (street drug)<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Carbon monoxide<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Snake Venom<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Tetanus<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Metabolic Abnormalities<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Hypothyroidism<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Hyperthyroidism<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Diabetic Ketoacidosis<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>
width="148" valign="top" style="width:2.05in;border:none;border-left:solid windowtext 1.0pt; mso-border-left-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Medication-induced<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;background:#B8CCE4; mso-background-themecolor:accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Inadvertent intravenous (IV) infiltration (e.g., amphotericin B, azathioprine, cyclosporine)<o:p></o:p>	width="148" valign="top" style="width:2.05in;border:none;border-right:solid windowtext 1.0pt; mso-border-right-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p> <o:p> </o:p> <o:p> </o:p> <o:p> </o:p> <o:p> </o:p>
width="148" valign="top" style="width:2.05in;border-top:none;border-left: solid windowtext 1.0pt;border-bottom:solid windowtext 1.0pt;border-right: none;mso-border-left-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt; background:#B8CCE4;mso-background-themecolor:accent1;mso-background-themetint: 102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>	width="148" valign="top" style="width:2.05in;border:none;border-bottom:solid windowtext 1.0pt; mso-border-bottom-alt:solid windowtext .5pt;background:#B8CCE4;mso-background-themecolor: accent1;mso-background-themetint:102;padding:0in 5.4pt 0in 5.4pt" | Cholesterol-lowering statins (e.g., Zocor, Lipitor, Crestor)<o:p></o:p>	width="148" valign="top" style="width:2.05in;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt; mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt; background:#B8CCE4;mso-background-themecolor:accent1;mso-background-themetint: 102;padding:0in 5.4pt 0in 5.4pt" | <o:p> </o:p>

•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

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports

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Resources

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Recent Related Research (from Pubmed)

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References

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