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Rhabdomyolysis - Coggle Diagram
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Rhabdomyolysis
Pathogenesis
compartment syndrome, hypovolemia
Rhabdomyolysis is a life-threatening disease that occurs when skeletal muscle is damaged and releases its cellular contents into circulation such as myoglobin, creatine kinase, and electrolytes
Due to the amount of myoglobin circulating, myoglobin exceeds protein binding and precipitates out of the plasma. This results in renal tubular obstruction, direct nephrotoxicity, or acute kidney injury.
The increase of intracellular Ca continually contract the muscles, disrupt the normal function of mitochondria, disrupt ATP formation, and activates phospholipase A2 which degrade plasma membranes
Clinical Manifestations
Some of the clinical manifestations of Rhabdomyolysis are muscle pain (shoulder/thigh/lower back), weakness, fatigue, swelling, and dark urine due to presence of myoglobin.
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Electrolyte abnormalities are also very common such as hyperkalemia due to the injured muscle and diminished renal function, hyperphosphatemia from damaged cells which results in hypocalcemia as Ca is deposited into damaged cells.
More symptoms of Rhabdomyolysis are decreased urine output, myalgia, and seizures.
Diagnostics
There are many tests for diagnosing Rhabdomyolysis but the chief diagnostic test is searching for the prescience of creatine kinase in the plasma.
Other lab tests for Rhabdomyolysis are complete blood count, metabolic panel, and urinalysis to detect myoglobin.
Since electrolyte abnormalities are common in Rhabdomyolysis, an electrolyte panels can be used to determine the levels of electrolytes specifically potassium and calcium levels.
Risk Factors
Rhabdomyolysis is caused by many things such as physical trauma to skeletal muscle, electrocution, major burns, excessive exercise, drugs such as statins and SSRI's, or alcohol abuse .
People who have inherited disorders such as McArdle's disease and Duchenne's muscular dystrophy are predisposed for Rhabdomyolysis.
Some more risk factors for Rhabdomyolysis are diabetic ketoacidosis, hypothyroidism, some viral and bacterial infections, and capillary leak syndrome.
Treatments
A common treatment for Rhabdomyolysis is intravenous fluids. The IV fluids (0.9% NaCl) will try to prevent kidney failure and also to maintain urine production.
Dialysis, although rarely needed, may be used to assist the kidneys in filtering waste.
The use of mannitol and sodium bicarbonate may be incorporated. Mannitol is used because it decreases osmotic swelling and edema which help restore skeletal muscle function.