Rhabdomyolysis is characterized by muscle necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage and the release Release Release of a virus from the host cell following virus assembly and maturation. Egress can occur by host cell lysis, exocytosis, or budding through the plasma membrane. Virology of toxic intracellular contents, especially myoglobin, into the circulation Circulation The movement of the blood as it is pumped through the cardiovascular system. ABCDE Assessment. Rhabdomyolysis can result from trauma or direct muscle injuries; however, non-exertional and non-traumatic etiologies ( heatstroke Heatstroke Heatstroke is an illness characterized as a core body temperature exceeding 40°C (104°F) with accompanying neurological symptoms including ataxia, seizures, and/or delirium. Heatstroke is usually due to the body's inability to regulate its temperature when challenged with an elevated heat load. Heatstroke, immobilization Immobilization Delirium, medication side effects) can also lead to muscle breakdown. The classic triad of symptoms includes myalgia Myalgia Painful sensation in the muscles. Ion Channel Myopathy, weakness, and tea-colored urine Urine Liquid by-product of excretion produced in the kidneys, temporarily stored in the bladder until discharge through the urethra. Bowen Disease and Erythroplasia of Queyrat, but the presentation Presentation The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck. Normal and Abnormal Labor can be nonspecific. History and work-up generally point to diagnosis based on elevated creatine Creatine An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine. Acute Kidney Injury kinase levels, abnormal electrolytes Electrolytes Electrolytes are mineral salts that dissolve in water and dissociate into charged particles called ions, which can be either be positively (cations) or negatively (anions) charged. Electrolytes are distributed in the extracellular and intracellular compartments in different concentrations. Electrolytes are essential for various basic life-sustaining functions. Electrolytes with possible renal failure Renal failure Conditions in which the kidneys perform below the normal level in the ability to remove wastes, concentrate urine, and maintain electrolyte balance; blood pressure; and calcium metabolism. Renal insufficiency can be classified by the degree of kidney damage (as measured by the level of proteinuria) and reduction in glomerular filtration rate. Crush Syndrome, and dark urine Urine Liquid by-product of excretion produced in the kidneys, temporarily stored in the bladder until discharge through the urethra. Bowen Disease and Erythroplasia of Queyrat without RBCs RBCs Erythrocytes, or red blood cells (RBCs), are the most abundant cells in the blood. While erythrocytes in the fetus are initially produced in the yolk sac then the liver, the bone marrow eventually becomes the main site of production. Erythrocytes: Histology (indicating myoglobinuria). Management of rhabdomyolysis is by using intravenous fluid resuscitation Resuscitation The restoration to life or consciousness of one apparently dead. . Neonatal Respiratory Distress Syndrome.
Last updated: 12 Feb, 2021
Rhabdomyolysis is a syndrome marked by muscle necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage, resulting in the release Release Release of a virus from the host cell following virus assembly and maturation. Egress can occur by host cell lysis, exocytosis, or budding through the plasma membrane. Virology of toxic intracellular muscle constituents into the circulation Circulation The movement of the blood as it is pumped through the cardiovascular system. ABCDE Assessment (especially myoglobin).
Injury mechanisms of rhabdomyolysis:
1. Energy (ATP) depletion inhibits Na+/K+ ATPase function and increases intracellular
sodium
Sodium
A member of the alkali group of metals. It has the atomic symbol na, atomic number 11, and atomic weight 23.
Hyponatremia.
2. The 2Na+/Ca2+ exchanger increases intracellular
calcium
Calcium
A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes.
Electrolytes.
3. Ca2+ ATPase is not able to
pump
Pump
ACES and RUSH: Resuscitation Ultrasound Protocols out intracellular
calcium
Calcium
A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes.
Electrolytes due to energy depletion.
4. Intracellular
calcium
Calcium
A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes.
Electrolytes activates
proteases
Proteases
Proteins and Peptides such as phospholipase 2 (PLA2), which destroy the structural components of cell membranes and allow the entry of more
calcium
Calcium
A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes.
Electrolytes.
5.
Calcium
Calcium
A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes.
Electrolytes overload disrupts mitochondrial integrity and induces
apoptosis
Apoptosis
A regulated cell death mechanism characterized by distinctive morphologic changes in the nucleus and cytoplasm, including the endonucleolytic cleavage of genomic DNA, at regularly spaced, internucleosomal sites, I.e., DNA fragmentation. It is genetically-programmed and serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth.
Ischemic Cell Damage, leading to
necrosis
Necrosis
The death of cells in an organ or tissue due to disease, injury or failure of the blood supply.
Ischemic Cell Damage of muscle cells.
Acute kidney injury
Acute Kidney Injury
Acute kidney injury refers to sudden and often reversible loss of renal function, which develops over days or weeks. Azotemia refers to elevated levels of nitrogen-containing substances in the blood that accompany AKI, which include BUN and creatinine.
Acute Kidney Injury (
AKI
AKI
Acute kidney injury refers to sudden and often reversible loss of renal function, which develops over days or weeks. Azotemia refers to elevated levels of nitrogen-containing substances in the blood that accompany AKI, which include BUN and creatinine.
Acute Kidney Injury) in rhabdomyolysis (
enzymes
Enzymes
Enzymes are complex protein biocatalysts that accelerate chemical reactions without being consumed by them. Due to the body’s constant metabolic needs, the absence of enzymes would make life unsustainable, as reactions would occur too slowly without these molecules.
Basics of Enzymes*:
creatine
Creatine
An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine.
Acute Kidney Injury kinase,
aldolase
Aldolase
Becker Muscular Dystrophy,
lactate dehydrogenase
Lactate Dehydrogenase
Osteosarcoma):
After muscle destruction, myoglobin and
enzymes
Enzymes
Enzymes are complex protein biocatalysts that accelerate chemical reactions without being consumed by them. Due to the body’s constant metabolic needs, the absence of enzymes would make life unsustainable, as reactions would occur too slowly without these molecules.
Basics of Enzymes are released into the
circulation
Circulation
The movement of the blood as it is pumped through the cardiovascular system.
ABCDE Assessment, damaging
capillaries
Capillaries
Capillaries are the primary structures in the circulatory system that allow the exchange of gas, nutrients, and other materials between the blood and the extracellular fluid (ECF). Capillaries are the smallest of the blood vessels. Because a capillary diameter is so small, only 1 RBC may pass through at a time.
Capillaries: Histology and leading to leakage and
edema
Edema
Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity).
Edema.
Hypovolemia
Hypovolemia
Sepsis in Children and reduced renal
blood flow
Blood flow
Blood flow refers to the movement of a certain volume of blood through the vasculature over a given unit of time (e.g., mL per minute).
Vascular Resistance, Flow, and Mean Arterial Pressure are associated with
AKI
AKI
Acute kidney injury refers to sudden and often reversible loss of renal function, which develops over days or weeks. Azotemia refers to elevated levels of nitrogen-containing substances in the blood that accompany AKI, which include BUN and creatinine.
Acute Kidney Injury. Myoglobin cytotoxicity affects the kidney due to
lipid peroxidation
Lipid peroxidation
Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor.
Drug-induced Liver Injury and production of
reactive oxygen species
Reactive oxygen species
Molecules or ions formed by the incomplete one-electron reduction of oxygen. These reactive oxygen intermediates include singlet oxygen; superoxides; peroxides; hydroxyl radical; and hypochlorous acid. They contribute to the microbicidal activity of phagocytes, regulation of signal transduction and gene expression, and the oxidative damage to nucleic acids; proteins; and lipids.
Nonalcoholic Fatty Liver Disease. Tubular obstruction by myoglobin is also associated with
AKI
AKI
Acute kidney injury refers to sudden and often reversible loss of renal function, which develops over days or weeks. Azotemia refers to elevated levels of nitrogen-containing substances in the blood that accompany AKI, which include BUN and creatinine.
Acute Kidney Injury.
Tea-colored urine Urine Liquid by-product of excretion produced in the kidneys, temporarily stored in the bladder until discharge through the urethra. Bowen Disease and Erythroplasia of Queyrat of a patient being treated for rhabdomyolysis
Image: “ Urine Urine Liquid by-product of excretion produced in the kidneys, temporarily stored in the bladder until discharge through the urethra. Bowen Disease and Erythroplasia of Queyrat appearance” by the Department of General Medicine, Sri Ramachandra University Chennai, Tamil Nadu, India. License: CC BY 3.0Patient with rhabdomyolysis and
hyperkalemia
Hyperkalemia
Hyperkalemia is defined as a serum potassium (K+) concentration >5.2 mEq/L. Homeostatic mechanisms maintain the serum K+ concentration between 3.5 and 5.2 mEq/L, despite marked variation in dietary intake. Hyperkalemia can be due to a variety of causes, which include transcellular shifts, tissue breakdown, inadequate renal excretion, and drugs.
Hyperkalemia:
Electrocardiogram
Electrocardiogram
An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures.
Electrocardiogram (ECG) of a patient treated for rhabdomyolysis, showing peaked T waves and wide QRS. The patient had a serum
potassium
Potassium
An element in the alkali group of metals with an atomic symbol k, atomic number 19, and atomic weight 39. 10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte that plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance.
Hyperkalemia level of 8 mEq/L.