Rhabdomyolysis
| ↑ muscle breakdown, releasing toxic intracellular contents... a bit like Tumour lysis syndrome | |
|---|---|
| Etiology | - How many causes of metabolic stress can you think of? Great time for a surgical sieve. - Trauma, burns, Electrical injury, surgery - Thyroid storm, Diabetic ketoacidosis, HHS, myxoedema coma, viral infections, persistent high fever - Ischaemia: compartment syndrome, long clamp time or tourniquet time post-op, reperfusion/crush injury - Toxins: hyperthermic toxidromes (Serotonin syndrome), sympathomimetic toxicity - Malignant hyperthermia - Autoimmune: poly/dermatomyositis - inborn errors of metabolism, myopathies |
| Epidemiology | |
| Clinical presentation | Dark urine, fatigue Hyperkalaemia, ↑ CK, ↓ calcium |
| Pathogenesis | Renal impairment: - intraluminal cast formation - lipid peroxidation by haem - vasoconstriction ?by NO scavenging - free radical-mediated injury |
| Diagnostic investigations | Bloods: ↑ CK, ↑ K Urine: myoglobinuria |
| Management | Fluid resuscitation Potentially CRRT - remove myoglobin Poor evidence for bicarb to correct rhabdo-induced AKI - only for acidosis Ca replacement may exacerbate muscle injury? |