Transcript Rhabdomyolysis - faculty at Chemeketa

Rhabdomyolysis
By: Kevin Cummo
What is Rhabdomyolysis
• Rhabdomyolysis is the breakdown of muscle
fibers, specifically of the sarcolemma of
skeletal muscle, resulting in the release of
muscle fiber contents (myoglobin) into the
bloodstream.
Skeletal Muscle Cell
Source: (Muscle Anatomy
& Structure, 2007)
The sarcolemma is the cell membrane of a muscle cell.
The membrane is designed to receive and conduct stimuli
Why all the worry?
• When muscle is damaged, a protein pigment called
myoglobin is released into the bloodstream and
filtered out of the body by the kidneys.
• The broken down myoglobin may block the
structures of the kidney, causing damage such as
acute tubular necrosis or kidney failure.
• Dead muscle tissue may cause a large amount of
fluid to move from the blood into the muscle, leading
to hypovolemic shock. Causing reduced blood flow to
the kidneys.
What causes Rhabdomyolysis?
• May result from a large variety of diseases, TRAUMA, or toxic insults to
skeletal muscle
• Hereditary
• Risk Factors
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Alcoholism
Crush Injuries
Heat intolerance
Heatstroke
Ischemia or necrosis of the muscles
Low phosphate levels
Seizures
Severe exertion
Shaking chills
Trauma
Use or overdose of drugs
What are the symptoms of
Rhabdomyolysis?
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Muscle tenderness
Weakness of the affected muscles
General weakness
Muscle stiffness or aching
Abnormal urine color
Additionally some possible symptoms include
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Overall fatigue
Joint pain
Seizures
Weight gain
What are the possible complications of
Rhabdomyolysis?
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Kidney damage
Acute tubular necrosis
Acute renal failure
Hyperkalaemia
Cardiac arrest
Disseminated Intravascular Coagulation
Compartment syndrome
How do you test for Rhabdomyolysis?
• An examination reveals tender or damaged
skeletal muscles.
• Creatine Phosphokinase levels are very high.
• Serum myoglobin test is positive
• Serum potassium may be very high
• Urinalysis may reveal protein and be positive
for hemoglobin without evidence of red blood
cells on microscopic examination.
• Urine myoglobin test is positive.
How do you test for Rhabdomyolysis?
(cont.)
• This disease may also alter the results of the
following tests:
– Creatine Phosphokinase isoenzymes
– Urine creatinine
– Serum creatinine
 Creatinine is a product of metabolized creatine. If kidney function is
abnormal, creatinine levels will increase in the blood.
EMS Treatment
1. Immediately obtain intravenous access with a
large-bore catheter.
2. Administer isotonic crystalloid 500 mL/h and
then titrate to maintain a urine output of
200-300 mL/h.
Treatment (Cont.)
• Early and aggressive fluids (hydration) may prevent
complications by rapidly remove myoglobin out of the
kidneys. Administer isotonic crystalloid fluids (Normal
Saline or Lactated Ringer’s). Give as much fluid as you
would give a severely burned patient.
• Studies of patients with severe crush
injuries resulting in Rhabdomyolysis
suggest that the prognosis is better
when prehospital personnel provide
FLUID RESUCITATION!
Treatment (Cont.)
• Medicines that may be prescribed include
diuretics and sodium bicarbonate.
• Hyperkalemia should be treated if present.
Kidney failure should be treated as
appropriate.
Prognosis of Rhabdomyolysis
• The outcome varies depending on the extent
of kidney damage.
Source: Silberber, 2007
How can I prevent Rhabdomyolysis?
• Drink plenty of fluids after strenous exercise to
dilute the urine and flush the myoglobin out
of the kidney.
• Proper hydration is also necessary after any
condition or event that may involve damage
to skeletal muscle.
Now that you know…CHECK THIS OUT
• Rhabdomyolysis accounts for an estimated 815% of cases of acute renal failure.
• The overall mortality rate for patients with
Rhabdomyolysis is approximately 5%
• Rhabdomyolysis is more common in Males
than in Females
• May occur in infants, toddlers, and
adolescents
Hmmm…That’s weird...
• “Rhabdomyolysis was first reported in 1881, in
the German literature” (Abbeele, Parker,
1985).
• “Rhabdomyolysis was first described in the
victims of crush injury during the 1940-1941
London, England, bombing raids of World War
II” (Craig, 2006).
Bibliography
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Abbeele M.D. , A.D. Van den, and J. Anthony Parker, M.D. (April 9, 1985). Rhabdomyolysis.
Retrieved Nov. 15, 2007.
http://www.med.harvard.edu/JPNM/BoneTF/Case18/WriteUp18.html
Baggaley , DR. Paul. (1997). Rhabdomyolysis. Retrieved Nov. 15, 2007.
http://members.tripod.com/~baggas/rhabdo.html
Craig M.D., Sandy. (Nov. 30, 2006). Rhabdomyolysis. Retrieved Nov. 15, 2007.
http://www.emedicine.com/emerg/topic508.htm
Definition of Rhabdomyolysis. (March 14, 2003). Retrieved Nov. 15, 2007.
http://www.medterms.com/script/main/art.asp?articlekey=5352
Handler M.D., Jonathan A. (2000) Rhabdomyolysis: Taking it one day at a time. Retrieved Nov. 15,
2007. http://www.spiralnotebook.org/rhabdomyolysis/
Mayo Clinic Staff . (Aug. 16, 2006). Rhabdomyolysis from statin use: What are the symptoms?
Nov. 15, 2007. http://www.mayoclinic.com/health/rhabdomyolysis/AN01413
Muscal M.D.,Eyal. (Apr .13, 2007) . Rhabdomyolysis. Retrieved Nov. 15, 2007.
http://www.emedicine.com/ped/topic2003.htm
Muscle Anatomy & Structure. (2007) Retrieved Nov. 20, 2007. www.sport-fitness-advisor.com
Rhabdomyolysis: Kidney Failure and Damage. (2007). Retrieved Nov. 15, 2007.
http://www.rhabdomyolysis.org/
Silberber, Charles. (Aug. 14, 2007). MedlinePlus Medical Encyclopedia: Rhabdomyolysis.
Retrieved Nov. 15, 2007.
http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm