traumatic rhabdomyolysis


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A condition caused by prolonged and continuous external pressure on the limbs, resulting in disintegration of muscle and influx of myolytic products into the circulation
Lab Increased K+, purines, phosphates, lactic acid, thromboplastin, creatine kinase, creatine, BUN, hemoglobinuria, myoglobinuria

rhabdomyolysis

(rab?do-mi-ol'i-sis) (ol'i-sez?) plural.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. Rhabdomyolysis may result from crush injuries, the toxic effect of drugs or chemicals on skeletal muscle, extremes of exertion, 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. Kidney failure caused by rhabdomyolysis may produce life-threatening hyperkalemia and metabolic acidosis. The diagnosis is made in patients with appropriate histories or exposures who have elevated levels of serum or urine myoglobin or creatine kinase (CK). Management may include the infusion of bicarbonate-containing fluids (to enhance urinary secretion of myoglobin) or hemodialysis. See: reperfusion

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.

traumatic rhabdomyolysis

See: crush syndrome; reperfusion (2)
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References in periodicals archive ?
The early treatment of the patient with a combination of CVVHD and Cytosorb led to a rapid hemodynamic and metabolic stabilization and preservation of the renal function, suggesting that hemoadsorption might be a rescue therapy option in patients with severe septic shock and traumatic rhabdomyolysis.
Our experience was positive but remains limited: in order to assess the real effectiveness of CPFA in traumatic rhabdomyolysis, a multicentric study involving ICUs where major traumas are treated may be of interest.
Wood replies: Traumatic rhabdomyolysis is often a result of natural disasters such as earthquakes where patients are crushed by debris.
However, these beatings are often severe and lead to traumatic rhabdomyolysis (crush syndrome), and patients commonly present to rural emergency departments that have limited access to dialysis services.
Prevention of acute renal failure in traumatic rhabdomyolysis. Arch Intern Med 1984;144:277-80.

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