Rhabdomyolysis

Pathophysiology
 Muscle breakdown:1

↓ATP Myocyte

↑Na ↑Ca
Pulls Muscle contraction
fluid + decrese in ATP
into cell
Breakdown of
membrane via
proteases and
phospholipases...
. more damage
to ion channels

Rhabdomyolysis

Causes:2
Medication Induced How? Not medication Induced
Over Exertion Stimulants Trauma
Lack of siezure control
Temperature dysregulation Serotonin syndrome Muscle ischemia
Neuroleptic malignant syndrome
Metabolic: Hypo (K, Mg, Ca) Poor glucose management Infection
Hyperglycemia Diuretics
Drugs and toxins Very long list Genetic disorders
Autoimmune disorders

Presentation:
The Main Symptoms:
 Muscle pain, Dark urine, Weakness
o Others include diffuse swelling, necrotic skin changes, contracted muscles
 Symptoms are not definitive for diagnosing rhabdomyolysis and can vary by each patient.
 Electrolytes
Potassium High
Calcium Low
Phosphate High
Uric acid High
pH Low
Diagnosis:
Creatinin Ininital rise Peak 24-72 Fall 5-10
e Kinase 2-12 hours hours days

Creatinine Kinase
Normal 45 – 260 U/L
Diagnostic 5 x ULN OR >1,000 U/L
ARF Variable levels

Treatment:
Cause Rhabdomyolysis Consequences

- Cause:
o Stopping medications or treating the condition that caused the rhabdomyolysis
- Rhabdomyolysis:
Treatment Pearls
Lactated Ringers Target 200-300 mL/hr UO
Mannitol Don’t use unless severe with oliguria
0.5g/kg  0.1g/kg/hr WITH 100 mEq bicarbonate in 1 L ½ NS
Diuretics Do not use
FLUIDS, FLUIDS, FLUIDS
Does mannitol make sense in this situation??

- Consequences:
o Renal failure: AEIOU
 Hyperkalemia
 Elevated BUN
 Elevated calcium

1) Torres PA, Helmstetter JA, Kaye AM, Kaye AD. Rhabdomyolysis: pathogenesis, diagnosis, and treatment. Ochsner J. 2015;15(1):58-69.

2) Lee GX, et al. Rhabdomyolysis: evidence-based management in the emergency department. Emerg Med Pract. 2020;22(12):1-20.