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Rhabdomyolysis: Sheeba Hakak Amnch
Rhabdomyolysis: Sheeba Hakak Amnch
SHEEBA HAKAK
AMNCH
DEFINITION
Rhabdo = straited
myo = muscle
lysis = breakdown
DEFINITION
hypoxia
Direct injury to
membrane reperfusion
integrity
pathophysiology
Hypoxia leads to anaerobic metabolism
Increase in intracellular ca
Precipitation of
casts,occlude renal
tubules
myoglobin
O2 free
radicles,peroxidation
Damaged muscle of mem lipids
cells
rhabdomyolysis
What causes rhabdomyolysis?
• Direct Muscle Injury
– Crush injuries, deep burns, electrical injuries, acute necrotizing myopothy of
certain cancers, assaults with prolonged and vicious beating/repetitive blows
• Muscle Ischemia
– Interference with O2 delivery to cells and therefore limiting production of ATP
– Generalized ischemia from shock & hypotension, carbon monoxide poisoning,
profound systemic hypoxemia, localized compression leading to skeletal muscle
ischemia, tissue compression d/t immobilization of muscle, intoxicated/comatose
down for long periods, immobilization from acute SCI, compartment syndrome,
arterial/venous occlusions
Causes cont.
• Temperature Extremes
– Excessive Cold muscle perfusion, ischemia; freezing causes cellular
destruction
– Excessive Heat destroys cells & metabolic demands (every degree temp =
metabolic demand by ~ 10%) & if body can’t keep up with requirement, cellular
hypoxia anaerobic environment
– Malignant hyperthermia, neuroleptic malignant syndrome (d/t psychotropic
medications)
• Hypovolemia
• Metabolic Acidosis
• Respiratory failure
• serum myoglobin
– Until filters into urine causing characteristic coke-colored urine
• serum K+
– Major cause of morbidity/mortality d/t muscle breakdown & release K+ which
further by acidosis & RF
• Give calcium gluconate/chloride cautiously so as to prevent hypodynamic instability
• Early hypocalcemia
– Deposit of Ca in necrotic muscle, soft tissues calcify in necrosis
Diagnostics cont.
• Later hypercalcemia & hyperphosphatemia
– Phosphate and calcium leakage from damaged muscle cells give PO calcium
carbonate/hydroxide & calcium will follow being fixed when phosphate
distribution fixed (inverse relationship)
• Clotting Studies
– Useful in detecting DIC
• Urinalysis
– Will reveal presence of protein, brown casts, uric acid crystals
• Urine Dipstick
– Quick initial test
– Myoglobin will react to hemoglobin reagent on stick if positive, need to
determine if Hgb or myoglobin
Treatment
• ABC
• Fluids
• Treat hyperkalaemia
Fluids
• The treatment of rhabdomyolysis includes initial stabilization and
resusitation of the pt.