In this section
Warning: Undefined variable $nameCategory in /home/docthand/public_html/wp-content/themes/docthand/single-post_handbook.php on line 42
Warning: Attempt to read property "term_id" on null in /home/docthand/public_html/wp-content/themes/docthand/single-post_handbook.php on line 42
Rhabdomyolysis
Last updated 14th May 2021
Risk Factors
Muscle injury – vascular interruption, ischaemia-reperfusion, crush injury (trapped in buildings/ vehicles), seizures, extreme exercise, electrical injury, long lie (elderly – post fall, younger age group – post ingestion of recreational drugs)
Presentation
- Requires high index of clinical suspicion to allow recognition and treatment to avoid progression to acute renal failure +/- haemodialysis
- Muscle pain
- Worsening renal function – may develop oliguria, ‘tea coloured/ coca-cola coloured’ urine
Investigations
- Daily bloods – FBC, U&E, Creatinine kinase (CK), Phosphate
Raised urea, creatinine & CK, hypocalcaemia (myoglobin binds to calcium), hyperphosphatemia (released from myocytes), hyperkalaemia, DIC (low platelets) - Venous blood gas – raised lactate
- Urine dip – ‘positive’ for blood
- Urine microscopy – myoglobinuria
Management
- IV fluids – aggressive fluid resuscitation (urine output >100ml/hour)
- Correct electrolyte imbalance
- Sodium bicarbonate – increases myoglobin solubility and reduces metabolic acidosis
- Avoidance of iatrogenic renal insults – NSAIDs, IV contrast, ACE inhibitors, nephrotoxic antibiotics (eg – Gentamicin)
- Early input from renal team as some patients may require dialysis