{"id":3447,"date":"2019-11-28T12:19:40","date_gmt":"2019-11-28T12:19:40","guid":{"rendered":"http:\/\/edren.org\/ren\/education\/textbook\/rhabdomyolysis\/"},"modified":"2020-08-12T11:38:20","modified_gmt":"2020-08-12T11:38:20","slug":"rhabdomyolysis","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/education\/textbook\/conditions-that-affect-the-kidney\/rhabdomyolysis\/","title":{"rendered":"Rhabdomyolysis"},"content":{"rendered":"<p>Rhabdomyolysis is muscle damage caused by:<\/p>\n<ul style=\"list-style-type: disc;\">\n<li>Pressure or crush injury (e.g. prolonged unconsciousness)<\/li>\n<li>Ischaemic injury when blood supply is cut off<\/li>\n<li>Chemical injury (e.g. sometimes in those taking cholesterol-lowering statins)<\/li>\n<\/ul>\n<p>It was first described in the Second World War (1939-45) in people trapped beneath bombed buildings.\u00a0 Huge numbers of cases may occur after earthquakes.\u00a0 The damaged muscle releases a number of things as perfusion is restored:<\/p>\n<ul style=\"list-style-type: disc;\">\n<li><strong><span style=\"color: #993300;\">Myoglobin<\/span><\/strong> &#8211; this small haem-containing protein is filtered at the glomerulus because of its small size, but is toxic to renal tubular cells.\u00a0 Its toxicity may be reduced by alkalinising the urine by giving sodium bicarbonate.\u00a0 Urine containing a lot of myoglobin is dark brown to black.<\/li>\n<li><strong><span style=\"color: #993300;\">Potassium<\/span><\/strong> &#8211; the levels may rise very rapidly and dangerously in ARF caused by rhabdomyolysis, requiring frequent and intensive dialysis.<\/li>\n<li><strong><span style=\"color: #993300;\">Phosphate<\/span><\/strong> &#8211; Levels rise very high, causing calcium phosphate to precipitate and leading to low calcium levels.<\/li>\n<li><strong><span style=\"color: #993300;\">Muscle enzymes<\/span><\/strong> &#8211; Creatine Phosphokinase (CPK) levels rise very high (to values of tens of thousands), a useful diagnostic test.\u00a0 LDH and some other enzymes will be elevated too; so will uric acid.<\/li>\n<\/ul>\n<hr \/>\n<h3><strong><span style=\"color: #993300;\">Management<\/span><\/strong><\/h3>\n<ul style=\"list-style-type: disc;\">\n<li>Emergency treatment for hyperkalaemia.\u00a0 <a href=\"http:\/\/edren.org\/ren\/education\/textbook\/potassium\/\">More about potassium<\/a><\/li>\n<li>Preventive treatment &#8211; fluid resuscitation to restore circulation and urine output.\u00a0 Include sodium bicarbonate in large quantities to alkalinise the urine.<\/li>\n<li>Dialysis if urine output not restored and biochemical changes dangerous<\/li>\n<li>Muscle compartment pressure may rise very high after muscle damage, cutting off blood supply.\u00a0 Compartment pressures can be measured, and operations to cut open the affected compartments can save further muscle damage, and may be needed urgently.<\/li>\n<\/ul>\n<p>Recovery follows the standard pattern for <a href=\"http:\/\/edren.org\/ren\/education\/textbook\/arf-aki\/\">ARF<\/a>.<\/p>\n<hr \/>\n<h3><strong><span style=\"color: #993300;\">Further info<\/span><\/strong><\/h3>\n<ul>\n<li><a href=\"http:\/\/edren.org\/ren\/education\/textbook\/arf-aki\/\">Edrep page on ARF<\/a><\/li>\n<li><a href=\"http:\/\/edren.org\/ren\/handbook\/unithdbk\/aki-specialist\/acute-kidney-injury-management\/\">EdRen handbook on management of ARF<\/a><\/li>\n<li><a href=\"http:\/\/historyofnephrology.blogspot.com\/2010\/01\/bombs-and-rhabdomyolysis.html\">Bombs, earthquakes and rhabdomyolysis<\/a> &#8211; how natural and human disasters led to the discovery of this condition.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Rhabdomyolysis is muscle damage caused by: Pressure or crush injury (e.g. prolonged unconsciousness) Ischaemic injury when blood supply is cut off Chemical injury (e.g. sometimes in those taking cholesterol-lowering statins) It was first described in the Second World War (1939-45) in people trapped beneath bombed buildings.\u00a0 Huge numbers of cases\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/education\/textbook\/conditions-that-affect-the-kidney\/rhabdomyolysis\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3723,"menu_order":113,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-3447","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3447","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=3447"}],"version-history":[{"count":2,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3447\/revisions"}],"predecessor-version":[{"id":3671,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3447\/revisions\/3671"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3723"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=3447"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}