Al-Mehdi Rhabdomyolysis Flashcards
skeletal muscle breakdown due to trauma or ATP depletion
Rhabdomyolysis
5-10% of all acute kidney injury is due to this
rhabdomyolysis
what is released from rhabdomyocytes that causes acute kidney injury
myoglobin
K+ release from rhabdomyocytes causes
hyperkalemia
Ca2+ uptake into rhabdomyocytes causes
hypocalcemia
myalgia, tenderness, and muscle weakness are what features of rhabdomyolysis
local
tea-colored urine is what feature of rhabdomyolysis
systemic
specific pathology of rhabdomyolysis that leads to small amount of urine
Oliguria
sign of severe rhabdomyolysis that leads to uremic encephalopathy which lead to mental status changes
hyperuricemia
occurs in muscle groups (fascia); trauma releases fluid from cell; sensory abnormalities due to nerve compression
compartment syndrome
main labs of rhabdomyolysis (3)
increased CK-MM
increased creatinine
acidosis
main sign of rhabdomyolysis
myoglobinuria
what 3 things does elevated CK entail
Rhabdomyolysis, myocardial infarction, and muscular dystrophy
can lead to cardiac arrest, peaked T waves on ECGs, muscle paralysis
hyperkalemic periodic paralysis
to treat hyperkalemic periodic paralysis
calcium gluconate (reduces firing)
albuterol and insulin (increases Na/K ATPase to put K back in cell)
painless total body muscle weakness; mutation in L-type VGCC, increase in epi and insulin which brings K in cell
hypokalemic periodic paralysis
to treat hypokalemic periodic paralysis
PO K+
most specific test to do for rhabdomyolysis but its cost expensive and not readily available
myoglobin testing
these two things contain heme (blood)
myoglobin and hemoglobin
pink serum + urine positive for heme (blood)
hemolysis
serum NOT pink + urine positive for heme (blood)
rhabdomyolysis
proximal tubular necrosis and distal tubule obstruction cause
acute kidney failure
will BUN levels increase or decrease in rhabdomyolysis
decrease
neutral charge small molecule: (filtered or not)
all filtered
positive charge small molecule like myoglobin: (filtered or not)
all filtered
positive charge large molecule: (filtered or no)
some filtered
negative charge large molecule: (filtered or no)
barely filtered
main isoform of creatine kinase in skeletal muscle
CK-MM
most sensitive test to confirm rhabdomyolysis
CK-MM
myopathy and hepatitis are side effects of what drug for rhabdomyolysis
statins
only statin that doesn’t have SE of myopathy and hepatitis for rhabdomyolysis
Pravastatin
a statin and its inhibitor like grapefruit juice can lead to what
rhabdomyolysis
1st line of treatment for rhabdomyolysis that filters proximal tubule
normal saline
2 things used to alkalinize urine and protect distal tubule
NaCHO3 (sodium bicarbonate) + acetazolamide
number in mM that is a threat of cardiac arrest
> 8.5
hyperkalemia lowers or brings resting potential up
brings it up (will depolarize membrane)
lowers threshold to be closer to resting potential and increases firing
hypocalcemia
raises threshold and makes it harder to depolarize cell
hypercalcemia
treatment of hyperkalemia that does not affect plasma K+ levels
calcium gluconate
what increases K+ excretion
dialysis
what brings K+ back into the cell, lowering serum K+ levels
albuterol and insulin
to treat hypocalcemia
diuresis (fluid + diuretics)
what NOT to treat hypocalcemia with
Ca2+
