Rhabdomyolysis, Muscular injury 4.62/5 (13)

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Rhabdomyolysis (Rhabdomyolysis) (ICD-10 M 62.8)

Definition

Severe damage in (cross-stripped) muscle tissue (muscle cells). Proteins (among other things myoglobin) from muscle cells are released to the bloodstream and can damage the kidneys. muscle enzyme Creatine kinase (CK) is very high in the blood.

Rhabdomyolysis. Muscle damage causes the CK enzyme to be released in large quantities and via the bloodstream damage the kidneys. The urine turns "cola" brown. By AquapatMedia / creativecommons.org /Wikimedia Commons. CC BY SA 3.0

Disease Cause

Many options of which for hard physical training are among the most common:

Rhabdomyolysis may occur during exercise. City www.localfitness.com.au - Own work, CC BY-SA 3.0

Symptoms

  • Mild forms (moderately elevated CK) may have few symptoms
  • Muscle Pain
  • Muscle weakness
  • Brown-colored urine: "Coca-Cola urine"
  • Muscle swelling
  • Other

Diagnosis

In the blood, creatine kinase (CK) (alternatively also LD and ASAT) is measured which is released from damaged muscle cells

  • CK values ​​above 5 x upper reference range or> 5000 U / l are typical.
    • In differential diagnosis Myositis (inflammatory connective tissue disease) CK is rarely seen more than 15.000 U / L, but in rhabdomyolysis, CK 30.000 to 100.000 U / L is not uncommon
  • At CK more than 10.000 U / L there is a risk of kidney damage (myoglobin caused)
  • CK can still rise 1-XNUM days after the triggering event
  • Elevated CK levels are expected to be halved by approx. every 24-36 hours if the triggering cause is removed. Normalization within 3-5 days is expected
  • Myoglobin is excreted in the urine and causes a rash of "blood" on the urine, but without erythrocytes by microscopy
  • Exclude (dermato) myositis
  • Tissue sample from muscle (biopsy) shows cell death (necrosis) without inflammatory changes (unlike myositis and some other muscle diseases)

Incorrect diagnosis? (Similar diseases / differential diagnoses)

  • Myositis
    • Not so high CK values, ANA test most often turns out, slower disease onset
    • Dermatomyositis with eczema
  • Guillain-Barre syndrome
    • Not elevated CK
    • paralysis
  • Children: Infections (viruses, bacteria), injuries (including child abuse), enzyme defects

Treatment

The purpose is first and foremost to prevent kidney damage / renal failure

  • Removing Causing Cause (Medicinal Product, Other Chemical Substance)
  • Prevent shock and maintain kidney function
    • Intravenous fluid (0,9% NaCl)
    • Electrolyte interference correction (which is common)
    • Alkalization of urine to PH 7-8
    • Dialysis in severe renal failure

Medical prognosis

Life expectancy depends on the underlying cause, and whether salts in the blood (electrolytes) and kidneys are severely affected. CK value alone is not a good parameter for the forecast. Most people with exercise-induced rhabdomyolysis regain normal kidney and muscle function over time. In severe rhabdomyolysis after injuries and in need of treatment in the intensive care unit, mortality occurs in more than 20% of cases.

Literature


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