2. Definition
Breakdown of muscle
fiber resulting in the
release of muscle fiber
content into the
circulation
3. Development
Injury to the muscle
Accumulation of Sodium
Leads to increased intracellular calcium
concentrations
4. Development
This process leads to
muscle cell lysis
Causes the release of
intracellular
components into
extracellular fluid
and circulation
Ruptured Muscle Cells
5.
6. Myoglobin
Oxygen-binding protein found in the skeletal
muscle
Gets released into bloodstream upon muscle
damage
May cause kidney failure by blocking the
tubules of the kidneys
Breaks down further into potentially toxic
compounds, which can also cause kidney failure
7. Hyperkalemia
98% of potassium resides within cells
Skeletal breakdown releases large quantities of
potassium
May cause disruptions in heart rhythm
May potentially cause cardiac arrest
Most life-threatening consequence
8. Massive Muscle Necrosis
Will cause massive fluid shifts from the
bloodstream into the muscle
Will reduce plasma volumes
Will lead to shock
Will reduce blood flow to the kidneys
9. Causes
Severe exertion
Ischemia or necrosis
Use or overdose of drugs
Crush injuries and trauma
Heatstroke
Alcoholism
Hereditary
10. Severe Exertion
Exertion and heatstroke are the most common
causes of rhabdomyolysis
Untrained people, vigorous exercise, hot humid
weather
Eccentric contractions – muscles are
lengthening while trying to contract
Very low risk of acute renal failure
11. Crush Injury andTrauma
Due to direct muscle injury and ischemia
Also a risk in reperfusion after prolonged
ischemia
Exchange of calcium for excess IC sodium which
has accumulated during the ischemic period
13. Signs
Reddish-brown urine
Reddened overlying skin with local swelling
Fever
Tachycardia
May be tender upon palpation
Low urine output
14. Symptoms
Muscle tenderness
Muscle stiffness
Muscle pain
General malaise
Nausea
Vomiting
Agitation
Confusion
Decreased level of
consciousness
50% of patients will
present with pain in thighs,
calves, and lower back
15. WhatTo Look For
Need very focused history
What was pt. doing before symptoms appeared
(sporting event, military)
Consider air temperature
Ask pt. about nutrition and hydration
16. Lab Results
Myoglobin present in urine (gives urine dark
color)
Very high CK (creatine kinase) levels in the
bloodstream
Serum potassium high
Not all pt. with rhabdo. have myoglobin in
urine, but all pt. who have myoglobin in urine
have rhabdo.
17. Treatment
Early and aggressive hydration to eliminate
myoglobin out of the kidneys
Consider diuretic to help aid in flushing the
pigment out of the kidneys
If sufficient urine output, may give bicarbonate
to maintain an alkaline urine state (helps
prevent the dissociation of myoglobin into
toxins)
18. Treatment
In severe cases, dialysis for up to 3 weeks
Treat hyperkalemia
Treat hypercalcemia
Treat other electrolyte imbalances
