Rhabdomyolysis

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Definition/Description

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

Causes

Causes for rhabdomyolysis can be broken down into 2 categories, hereditary causes and acquired 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.  Disorders of lipid metabolism include malignant hyperthermia, mitochondrial disorders, as well as other genetic disorders.

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.

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

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

File:Table 2.1.png

Blood samples are taken

from 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.

 Urinalysis

File:Table 3.png

Urine 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.

Causes

Causes for rhabdomyolysis can be broken down into 2 categories, hereditary causes and acquired 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.  Disorders of lipid metabolism include malignant hyperthermia, mitochondrial disorders, as well as other genetic disorders.

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.

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

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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