rhabdomyolysis

(rab″dō-mī-ol′ĭ-sĭs)

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(rab″dō-mī-ol′ĭ-sēz″)
pl. rhabdomyolyses [rhabdo- + myo- + -lysis]
An acute, sometimes fatal disease in which the by-products of skeletal muscle destruction accumulate in the renal tubules and produce acute renal failure, other internal organ injury, and, occasionally, death. Kidney failure caused by rhabdomyolysis may produce life-threatening hyperkalemia and metabolic acidosis.

INCIDENCE
The incidence of death from statin-induced rhabdomyolysis is approx. 1 in 5,000,000 patients.

CAUSES
Rhabdomyolysis may result from crush injuries, the toxic effect of drugs or chemicals on skeletal muscle, extremes of exertion, heatstroke, sepsis, shock, electric shock, and severe hyponatremia. Lipid-lowering drugs such as statins (pravastatin, simvastatin) and/or fibrates (gemfibrozil) are among the commonly prescribed drugs that put patients at risk for rhabdomyolysis.

DIAGNOSIS
The diagnosis is made in patients with appropriate histories or toxic exposures who have elevated levels (five times the upper limit of normal) of creatine kinase (CK).

TREATMENT
Management includes the infusion of bicarbonate-containing fluids (to enhance urinary secretion of myoglobin) or hemodialysis.

PATIENT CARE
The goals of treatment are to prevent and treat renal dysfunction, reverse electrolyte abnormalities, and correct the underlying cause. Patients are hydrated aggressively with a goal of achieving urine output between 200 and 300 mL/hr. If urine output does not increase with hydration, loop and osmotic diuretics are prescribed to promote diuresis. Dialysis may be needed for the 10% to 20% of patients with rhabdomyolysis who develop renal failure. Urinary alkalinization (as with sodium bicarbonate) increases myoglobin solubility in the urine and thus its elimination from the body. The patient with rhabdomyolysis should also be monitored closely for electrolyte disturbances (hypocalcemia, hyperkalemia) and dysrhythmias and corrections made as quickly as possible. When localized muscle injuries are present (as after trauma) and compartment syndrome is suspected, direct measurement of compartment pressures is used to diagnose the need for fasciotomy. Bedrest is maintained throughout the acute illness phase. As the patient recovers, physical therapy will help maintain range of motion and prevent other complications of immobilization in hospital.
SEE: reperfusion

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