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Rhabdomyolysis Causes

Rhabdomyolysis and its associated complications usually occur in patients who were injured in major disasters including violent bombings and earthquakes. Basically, any factor -- whether physical, chemical, or biological -- that can damage the muscle can cause rhabdomyolysis. Muscle damage induces a release of the breakdown products of damaged muscle cells into the bloodstream. Some products such as myoglobin are detrimental to the kidneys and may in fact cause severe kidney failure. In general, the causes of rhabdomyolysis can be classified as physical or nonphysical. In the former, the disease is confined to a particular part of the body. In the latter, the disease can simultaneously affect all muscles.

Rhabdomyolysis Definition

Rhabdomyolysis is described as the rapid breakdown (i.e. lysis) of the skeletal muscle tissue (i.e. rhabdomyo) as a consequence of a prior injury to muscle tissue.

Rhabdomyolysis Diagnosis

Rhabdomyolysis may be suspected in patients who have suffered severe injuries, trauma, or prolonged immobilization. However, a definite diagnosis is often made only at a later stage, particularly when kidney function begins to deteriorate. Abnormally high levels of creatinine and urea, as well as a distinct decrease in urine output combined with reddish urine discoloration usually indicate rhabdomyolysis. To date, the most reliable diagnostic step is screening for blood levels of creatine kinase (CK), an enzyme released by damaged muscle. Levels greater than 5 times the ULN (i.e. upper limit of normal) usually confirm the diagnosis.

Rhabdomyolysis Symptoms and Signs

Rhabdomyolysis usually presents with tenderness, pain, weakness, and swelling (i.e. edema) of a previously injured or strained muscle. If swelling is extremely rapid (e.g. after being freed from a collapsed building), shock and low blood pressure may occur as a result of decreased fluid in the bloodstream. The swelling of damaged muscles sometimes cause compartment syndrome, a condition in which the swollen muscle of surrounding tissues are compressed in the same fascial compartment. This, in turn, results in damage or loss of function in the affected areas. When compartment syndrome occurs, there may be a decrease in blood supply, a decrease in sensation, or pain in the parts of the body involved. The release of the components of muscle tissue into the bloodstream disrupts the body's electrolytes, thus leading to vomiting, nausea, coma, confusion, and cardiac arrhythmias in patients.

Rhabdomyolysis Treatment

Treatment of rhabdomyolysis usually involves intravenous fluids to preserve kidney function and treat shock. In early stages, abnormal electrolyte levels may also need correction. In cases that present with acute renal failure, dialysis is often necessitated.

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