Rhabdomyolysis

Rhabdomyolysis is a condition of which rapid muscle breakdown occurs. The term ‘rhabdomyo’ refers to skeletal muscle where as ‘lysis’ means the breakdown. The destruction of muscle may be caused by physical trauma such as from an accident, biological factors like infection for an example and chemical factors such as medicine.


The damage done to the muscle tissues, however leads to the release of breakdown products of muscle cells, a protein precisely called as myoglobin into the bloodstream. These breakdown products which circulating in the bloodstream clogs up the kidney tubules upon reaching the kidneys and hence causes acute kidney failure. Besides the damage done to the kidney, the normal composition of the electrolytes also gets disrupted by the muscle tissue components that are released into the bloodstream. This results in nausea, vomiting, confusion, coma and also abnormal heart rate. An abnormal heart rate is caused by the increase in potassium level in the body.


A patient diagnosed with rhabdomyolysis exhibits symptoms like pain in the muscle in terms of achiness and weakness. This is solely due to the inflammation caused by the affected muscle. Swelling of the affected area can be seen clearly and often damages other tissues in the muscle. It can also lead to permanent damage to the affected muscle or limb. Occasionally compartment syndrome may happen, where the compression by swollen muscle of surrounding tissues in the nerves and blood vessels, leading to damage or loss of function in the part of the body supplied by these structures. Symptoms of this complication include decreased blood supply, decrease in sensation, or pain in the affected limb.


Clinical tests that are being conducted to diagnose rhabdomyolysis consists of urinalysis and also blood test. Urinalysis is one of the most important test that can be done to detect rhabdomyolysis. In urinalysis, the urine sample would appear dark in color. Further dipstick method analysis would show the positive result for “blood”. This indicates excess myoglobulin is present in the urine that transforms the urine color into dark colored urine. Blood test is being conducted to detect the level of creatine kinase(CK) in blood. Enzyme creatine kinase(CK) is present in large quantities inside muscle cells, and when the muscle cells break down, the creatine kinase goes into the blood stream, and it can be measured. A creatine kinase level that is five times its normal levels is consistent with a diagnosis of rhabdomyolysis.

Acute kidney failure which caused by rhabdomyolysis can be treated with hemodialysis. Fluid therapy is also used to treat rhabdomyolysis. This is mainly to treat shock and preserve the kidney function. It is basically done through the administration of intravenous fluid which usually revolves the use of saline. This therapy ensures sufficient circulating volume to deal with the muscle cell swelling and prevent the deposition of the myoglobin in the kidneys. 6 to 12 liters over 24 hours are recommended for this treatment. Additionally, the abnormal level of electrolytes in the body can be corrected and maintained particularly the calcium level.


Reference:

http://en.wikipedia.org/wiki/Rhabdomyolysis