Rhabdomyolysis

RhabdomyolysisParamedic Program Fall 2006

Irina Bubnova

Definition Breakdown of

muscle fiber resulting in the release of muscle fiber content into the circulation

Development Injury to the muscle Accumulation of Sodium Leads to increased intracellular

calcium concentrations

Development This process leads

to muscle cell lysis

Causes the release of intracellular components into extracellular fluid and circulation

Ruptured Muscle Cells

Myoglobin Oxygen-binding protein found in the

skeletal muscle Gets released into bloodstream upon

muscle damage May cause kidney failure by blocking the

tubules of the kidneys Breaks down further into potentially toxic

compounds, which can also cause kidney failure

Hyperkalemia 98% of potassium resides within cells Skeletal breakdown releases large

quantities of potassium May cause disruptions in heart rhythm May potentially cause cardiac arrest Most life-threatening consequence

Massive Muscle Necrosis Will cause massive fluid shifts from the

bloodstream into the muscle Will reduce plasma volumes Will lead to shock Will reduce blood flow to the kidneys

Causes Severe exertion Ischemia or necrosis Use or overdose of drugs Crush injuries and trauma Heatstroke Alcoholism Hereditary

Severe Exertion Exertion and heatstroke are the most

common causes of rhabdomyolysis Untrained people, vigorous exercise,

hot humid weather Eccentric contractions – muscles are

lengthening while trying to contract Very low risk of acute renal failure

Crush Injury and Trauma Due to direct muscle injury and

ischemia Also a risk in reperfusion after

prolonged ischemia Exchange of calcium for excess IC

sodium which has accumulated during the ischemic period

Hereditary

McArdle’s disease Selective necrosis

of type 2 muscle fibers

Induced by vigorous exercise

Relieved by rest

Signs Reddish-brown urine Reddened overlying skin with local

swelling Fever Tachycardia May be tender upon palpation Low urine output

Symptoms Muscle tenderness Muscle stiffness Muscle pain General malaise Nausea Vomiting Agitation

Confusion Decreased level of

consciousness 50% of patients will

present with pain in thighs, calves, and lower back

What To Look For Need very focused history What was pt. doing before symptoms

appeared (sporting event, military) Consider air temperature Ask pt. about nutrition and hydration

Lab Results Myoglobin present in urine (gives urine

dark color) Very high CK (creatine kinase) levels in

the bloodstream Serum potassium high Not all pt. with rhabdo. have myoglobin

in urine, but all pt. who have myoglobin in urine have rhabdo.

Treatment Early and aggressive hydration to

eliminate myoglobin out of the kidneys Consider diuretic to help aid in flushing

the pigment out of the kidneys If sufficient urine output, may give

bicarbonate to maintain an alkaline urine state (helps prevent the dissociation of myoglobin into toxins)

Treatment In severe cases, dialysis for up to 3

weeks Treat hyperkalemia Treat hypercalcemia Treat other electrolyte imbalances

Any Questions?

Works Cited http://web3.infotrac.galegroup.com/itw/infomark/37/452/119618666w3/purl=rc1_HRCA_0_A149557602&dyn=5!xrn_1_0_A149557602?sw_aep=multnomah_main

http://web3.infotrac.galegroup.com/itw/infomark/37/452/119618666w3/purl=rc1_HRCA_0_A146679410&dyn=5!xrn_4_0_A146679410?sw_aep=multnomah_main




http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm

http://members.tripod.com/~baggas/rhabdo.html

http://en.wikipedia.org/wiki/Rhabdomyolysis







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Rhabdomyolysis