Rhabdomyolysis, Muscular injury 4.55/5 (11)

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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.

Rhabdomyolysis. By AquapatMedia / creativecommons.org /Wikimedia Commons. CC BY SA 3.0

Disease Cause

Many possibilities:

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

Symptoms

Diagnosis

In the blood, creatine kinase (CK) (alternatively also LD and AST) 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 renal injury (myoglobin induced)
  • CK can still rise 1-XNUM days after the triggering event
  • Elevated CK levels are expected to halve approximately every 24-36 hours if the triggering cause is removed. Normalization within 3-5 days is expected
  • Myoglobin is excreted in urine and causes manifestation on blood on urine stix, but without erythrocytes by microscopy
  • Exclude (dermato) myositis
  • Muscle biopsy shows necrosis (cell death) without inflammatory changes (as in myositis and some other muscular diseases)

Incorrect diagnosis? (Similar diseases / differential diagnoses)

  • Myositis
    • Not that high CK values, ANA tests, slower disease start
    • Dermatomyositis with eczema
  • Guillain-Barre syndrome
    • Not elevated CK
  • 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)
    • Alkalisation of the urine to PH 7-8
    • Dialysis in severe renal failure

Medical prognosis

Life expectancy depend on the underlying cause, and if electrolytes and kidneys are severely affected. CK value alone is not a good parameter for the prognosis. Most of the exercise-induced rhabdomyolysis regains normal renal and muscle functions over time. In severe rhabdomyolysis after injury and in need of intensive care treatment, mortality is present in more than 20% of cases.

Literature


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