Rhabdomyolysis is the rapid breakdown of skeletal muscle tissue due to traumatic injury, either mechanical, physical or chemical. The principal result is a large release of the CK enzymes and other cell byproducts into the blood system and acute renal failure due to accumulation of muscle breakdown products, several of which are injurious to the kidney. Treatment is with intravenous fluids, and dialysis if necessary. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // M00-M99 - Diseases of the musculoskeletal system and connective tissue (M00-M25) Arthropathies (M00-M03) Infectious arthropathies (M00) Pyogenic arthritis (M01) Direct infections of joint in infectious and parasitic diseases classified elsewhere (M02) Reactive arthropathies (M023) Reiters disease (M03) Postinfective and reactive arthropathies in diseases classified elsewhere (M05-M14... // S00-T98 - Injury, poisoning and certain other consequences of external causes (S00-S09) Injuries to the head (S00) Superficial injury of head (S01) Open wound of head (S02) Fracture of skull and facial bones (S03) Dislocation, sprain and strain of joints and ligaments of head (S04) Injury of cranial nerves... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... A top-down view of skeletal muscle Skeletal muscle is a type of striated muscle, usually attached to the skeleton. ... Creatine Kinase Creatine kinase (CK), also known as phosphocreatine kinase or creatine phosphokinase (CPK) is an enzyme (EC 2. ... The kidneys are organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ...

Causes

Injury leading to rhabdomyolysis can be due to mechanical, physical and chemical causes:

• mechanical: crush trauma, burns, excessive exertion, intractable convulsions, choreoathetosis, surgery, compression by a tourniquet left for too long, local muscle compression due to comatose states, compartment syndrome, rigidity due to neuroleptic malignant syndrome
• physical: high fever or hyperthermia, electric current, extreme physical exertion (although most heavy exercise does not cause kidney damage)^[1]
• chemical: metabolic disorders, anoxia of the muscle (e.g. Bywaters' syndrome, toxin- and drug-related); various animal toxins, certain mushrooms like Tricholoma equestre, some antibiotics, statins, first-generation H1-receptor antagonists (e.g. diphenhydramine), alcohol, heritable muscle enzyme deficiencies, electrolyte abnormalities, infections, or endocrinopathies. Skeletal muscle relaxants that are consumed in overdose are rarely associated with this condition.^[2]

Any drug which directly or indirectly impairs the production or use of adenosine triphosphate (ATP) by skeletal muscle, or increases energy requirements so as to exceed ATP production, can cause rhabdomyolysis.^[3] This article is about epileptic seizures. ... Choreoathetosis is a combination of chorea and athetosis. ... “Surgeon” redirects here. ... A tourniquet can be defined as a constricting or compressing device used to control venous and arterial circulation to an extremity for a period of time. ... For other uses, see Coma (disambiguation). ... Compartment syndrome is characterized by increased pressure within one or more fascial compartments so that vascular perfusion is compromised. ... Neuroleptic malignant syndrome (NMS) is a life-threatening, neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. ... An analogue medical thermometer showing the temperature of 38. ... This article does not cite any references or sources. ... Electric current is the flow (movement) of electric charge. ... A metabolic disorder is a medical disorder which affects the production of energy within individual human (or animal) cells. ... Asphyxia is a condition of severely deficient supply of oxygen to the body. ... Crush syndrome (also traumatic rhabdomyolysis or Bywaters syndrome) is a serious medical condition characterized by major shock and renal failure following a crushing injury to skeletal muscle. ... Basidiocarps (mushrooms) of the fungus Leucocoprinus sp. ... Tricholoma equestre or Tricholoma flavovirens, also known as Man on horseback or Yellow knight is a formerly widely eaten but hazardous fungus of the Tricholoma genus that forms ectomycorrhiza with pine trees. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... Lovastatin, the first statin to be marketed The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic agents, used as pharmaceutical agents to lower cholesterol levels in people with or at risk for cardiovascular disease. ... Diphenhydramine hydrochloride (trade name Benadryl, as produced by J&J, or Dimedrol outside the U.S. & Canada. ... Alcoholic beverages An alcoholic beverage (also known as booze in slang term) is a drink containing ethanol, commonly known as alcohol, although in chemistry the definition of alcohol includes many other compounds. ... Adenosine 5-triphosphate (ATP) is a multifunctional nucleotide that is most important as a molecular currency of intracellular energy transfer. ...

Pathophysiology

Severe cases of rhabdomyolysis often result in myoglobinuria, a condition where the myoglobin from muscle breakdown spills into the urine, making it dark, or "tea colored" (myoglobin contains heme, like hemoglobin, giving muscle tissue its characteristic red color). This condition can cause serious kidney damage in severe cases. The injured muscle also leaks potassium, leading to hyperkalemia, which may cause fatal disruptions in heart rhythm. In addition, myoglobin is metabolically degraded into potentially toxic substances for the kidneys. Massive skeletal muscle necrosis may further aggravate the situation, by reducing plasma volumes and leading to shock and reduced bloodflow to the kidneys. Myoglobinuria is the presence of myoglobin in the urine, usually associated to rhabdomyolysis or muscle destruction. ... An X-ray diffraction image for the protein myoglobin. ... This article or section is in need of attention from an expert on the subject. ... Structure of Heme b A heme or haem is a prosthetic group that consists of an iron atom contained in the center of a large heterocyclic organic ring called a porphyrin. ... Structure of hemoglobin. ... Acute renal failure (ARF) is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. ... General Name, symbol, number potassium, K, 19 Chemical series alkali metals Group, period, block 1, 4, s Appearance silvery white Standard atomic weight 39. ... Hyperkalemia is an elevated blood level (above 5. ... Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... Toxic redirects here, but this is also the name of a song by Britney Spears; see Toxic (song) Look up toxic and toxicity in Wiktionary, the free dictionary. ... Necrosis (in Greek Νεκρός = Dead) is the name given to accidental death of cells and living tissue. ... Blood plasma is the liquid component of blood, in which the blood cells are suspended. ... This article is about the medical condition. ...

Diagnosis

The diagnosis is typically made when an abnormal renal function and elevated CPK are observed in a patient. To distinguish the causes, a careful medication history is considered useful. Testing for myoglobin levels in blood and urine is rarely performed due to its cost, but may be useful. In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... Creatine Kinase Creatine kinase (CK), also known as phosphocreatine kinase or creatine phosphokinase (CPK) is an enzyme (EC 2. ... An X-ray diffraction image for the protein myoglobin. ...

Often the diagnosis is suspected when a urine dipstick test is positive for blood, but no cells are seen on microscopic analysis. This suggests myoglobinuria, and usually prompts a measurement of the serum CPK, which confirms the diagnosis.

Therapy

The main therapeutic measure is hyperhydration (by administering intravenous fluids), and if necessary the use of osmotic diuretics (to prevent fluid overload). Alkalinisation of the urine with bicarbonate reduces the amount of myoglobin accumulating in the kidney. This illustration shows where some types of diuretics act, and what they do. ... For baking soda, see Sodium bicarbonate In inorganic chemistry, a bicarbonate (IUPAC-recommended nomenclature: hydrogencarbonate) is an intermediate form in the deprotonation of carbonic acid. ... The kidneys are organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ...

As the electrolytes are frequently deranged, these may require correction, especially hyperkalemia (elevated potassium levels in the blood). Calcium levels are initially low (hypocalcemia), as circulating calcium precipitates in the damaged muscle tissue, presumably with phosphate released from intracellular stores. When the acute renal failure resolves, vitamin D levels rise rapidly, causing hypercalcemia (elevated calcium). Although this resolves eventually, high calcium levels may require treatment with bisphosphonates (e.g. pamidronate). Hyperkalemia is an elevated blood level (above 5. ... Calcium plays a vital role in the anatomy, physiology and biochemistry of organisms and of the cell, particularly in signal transduction pathways. ... In medicine, hypocalcaemia is the presence of less than a total calcium of 2. ... A phosphate, in inorganic chemistry, is a salt of phosphoric acid. ... Vitamin D is a fat soluble vitamin that contributes to the maintenance of normal levels of calcium and phosphorus in the bloodstream. ... Hypercalcaemia is an elevated calcium level in the blood. ... In pharmacology, bisphosphonates (also called: diphosphonates) is a class of drugs that inhibits the resorption of bone. ... Pamidronate disodium (brand name Aredia®) is a bisphosphonate used to prevent bone loss, and treat osteoporosis. ...

If the exacerbating cause includes overdose of skeletal muscle relaxants and/or tricyclic antidepressants, the treatment protocols include Gastric decontamination since it is fairly effective because the Anticholinergic effects of tricyclics and cyclobenzaprine delay gastric emptying and therefore it becomes possible to obtain tablet residues even after significant time elapse. Ventricular arrhythmias, QRS widening, or intraventricular conduction abnormalities should be treated with sodium bicarbonate 1 meq/kg IV bolus and repeated if arrhythmias persist. This should be followed by IV infusion of sodium bicarbonate to produce an arterial pH of 7.5; the mechanism of sodium bicarbonate's action in this role is unknown.^[2] However, sodium bicarbonate's beneficial effect on kidney function is known to be via the effects of alkalinisation both increasing the urinary solubility of myoglobin leading to its increased excretion,^[4] and stabilizing ferryl myoglobin complex so preventing myoglobin-induced lipid peroxidation.^[5][6] Chemical structure of the tricyclic antidepressant amitriptyline. ... In anatomy, the stomach (in ancient Greek στομάχι) is an organ in the alimentary canal used to digest food. ... In the heart, a ventricle is a chamber which collects blood from an atrium (another heart chamber) and pumps it out of the heart. ... Flash point Non-flammable. ...

References

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Footnotes

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External links

• Baggaley, P. (1997). Rhabdomyolysis. Retrieved on 2007-10-14.