Physiology-Rhabdomyolysis

Question 1

What muscle fibers are typically subject to rhabdomyolysis?

Answer 1

Type II fibers

Question 2

How do symptoms of exertional rhabdomyolysis normally present?

Answer 2

They usually start 24-48 hours after doing an unfamiliar form of eccentric exercise. The patient will normally present with myalgias, muscle weakness and dark urine (from myoglobin).

Question 3

What is the main focus of treatment of rhabdomyolysis?

Answer 3

Underlying illness, compartment syndrome, hypovolemia and management of metabolic disorders. The main goal is to prevent acute renal failure.

Question 4

Why do marathon runners not need medical care after a run when kids at basic training need care after the first few days to prevent renal failure?

Answer 4

Renal failure from rhabdomyolysis is likely a “perfect storm” of heat stress, dehydration, NSAIDs, infection, myopathy etc…

Question 5

How do CK levels vary among race and gender?

Answer 5

“Normal” levels are around 150. African Americans and males have elevated average levels.

Question 6

You see a patient in the E.R. with high CK levels. What do you do?

Answer 6

IV fluids, supportive care and watch to see what unfolds

Question 7

At what CK level do you worry about renal failure?

Answer 7

5000

Question 8

What are the clinical guidelines for diagnosing someone with rhabdomyolysis?

Answer 8

Severe muscle pain from exercise and/or dark urine. CK levels 5x baseline. UA tests positive for myoglobin and test for renal failure.